98-9486. Mutual Recognition of the Food and Drug Administration and European Community Member State Conformity Assessment Procedures; Pharmaceutical GMP Inspection Reports, Medical Device Quality System Evaluation Reports, and Certain Medical Device ...  

  • [Federal Register Volume 63, Number 69 (Friday, April 10, 1998)]
    [Proposed Rules]
    [Pages 17744-17771]
    From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
    [FR Doc No: 98-9486]
    
    
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    DEPARTMENT OF HEALTH AND HUMAN SERVICES
    
    Food and Drug Administration
    
    21 CFR Part 26
    
    [Docket No. 95N-0185]
    RIN 0910-ZA11
    
    
    Mutual Recognition of the Food and Drug Administration and 
    European Community Member State Conformity Assessment Procedures; 
    Pharmaceutical GMP Inspection Reports, Medical Device Quality System 
    Evaluation Reports, and Certain Medical Device Premarket Evaluation 
    Reports
    
    AGENCY: Food and Drug Administration, HHS.
    
    ACTION: Proposed rule.
    
    -----------------------------------------------------------------------
    
    SUMMARY: The Food and Drug Administration (FDA) is proposing to amend 
    its regulations pursuant to an international agreement that is expected 
    to be concluded between the United States and the European Community 
    (EC) (Ref. 1). Under the terms of that agreement, FDA may normally 
    endorse good manufacturing practice (GMP) inspection reports for 
    pharmaceuticals provided by equivalent EC Member State regulatory 
    authorities and medical device quality system evaluation reports and 
    certain medical device premarket evaluation reports provided by 
    equivalent conformity assessment bodies. FDA is taking this action to 
    enhance its ability to ensure the safety and efficacy of 
    pharmaceuticals and medical devices through more efficient and 
    effective utilization of its regulatory resources. The agency is 
    requesting comments on the proposed rule.
    
    DATES: Comments by May 11, 1998. Comments must be received by the 
    Dockets Management Branch (address below) by 4:30 p.m. Eastern Standard 
    Time on May 11, 1998.
    
    ADDRESSES: Submit written comments to the Dockets Management Branch 
    (HFA-305), Food and Drug Administration, 12420 Parklawn Dr., rm. 1-23, 
    Rockville, MD 20857, fax 301-594-3215.
    
    FOR FURTHER INFORMATION CONTACT: Merton V. Smith, Office of 
    International Affairs (HFG-1), Office of External Affairs, Food and 
    Drug Administration, 5600 Fishers Lane, Rockville, MD 20857, 301-827-
    0910, or E-mail: ``MSmith@bangate.fda.gov''.
    
    SUPPLEMENTARY INFORMATION:
    
    I. Background and History
    
        On June 20, 1997, the United States and the EC concluded 
    negotiations of an agreement entitled ``Agreement on Mutual Recognition 
    between the United States of America and the European Community'' (also 
    called ``the MRA''). The MRA includes two sectoral annexes covering 
    products regulated by FDA. The medical device sectoral annex covers 
    medical device quality system-related inspection reports and premarket 
    evaluation reports. The pharmaceutical GMP sectoral annex covers 
    pharmaceutical GMP inspection reports. The MRA also includes sectoral 
    annexes covering products regulated by other U.S. regulatory agencies, 
    including telecommunication equipment, electromagnetic compatibility, 
    electrical safety, and recreational craft. Finally, the MRA includes an 
    ``umbrella'' agreement that contains general provisions applicable
    
    [[Page 17745]]
    
    to the operation of all of the sectoral annexes.
        At the conclusion of negotiations, the United States and the EC 
    agreed to submit the text of the MRA to their respective authorities to 
    complete the necessary procedures for approval and implementation (Ref. 
    2). For FDA, the procedures include publishing this proposed rule for 
    public comment.
        In this document, FDA has published relevant provisions of the two 
    FDA sectoral annexes and the umbrella agreement, some of which create 
    binding obligations. FDA will review all comments and will consider 
    those comments addressing its binding obligations under the agreement.
    
    II. Statutory Authority
    
        FDA has the authority to enter into and execute the MRA under the 
    Federal Food, Drug, and Cosmetic Act (the act) (21 U.S.C. 321 et seq.) 
    and the Public Health Service Act (the PHS Act) (42 U.S.C. 201 et 
    seq.). For drugs and medical devices, section 510(i)(3) of the act (21 
    U.S.C. 360(i)(3)) provides authority for FDA to enter into the MRA. 
    Section 510(i)(3) of the act provides that:
        The Secretary [FDA by delegation] is authorized to enter into 
    cooperative arrangements with officials of foreign countries to 
    ensure that adequate and effective means are available for purposes 
    of determining, from time to time, whether drugs or devices 
    manufactured, prepared, propagated, compounded, or processed by an 
    establishment * * * [described in this section], if imported or 
    offered for import into the United States, shall be refused 
    admission on any of the grounds set forth in section 801(a).
    (Ref. 3).
        The MRA and the pharmaceutical and medical device annexes represent 
    cooperative arrangements with officials from foreign countries. The 
    purpose of these arrangements is, among other things, to ensure FDA has 
    adequate and effective means to determine whether drugs or devices 
    offered for import are adulterated, misbranded, or in violation of 
    section 505 of the act (21 U.S.C. 355) (Ref. 4). FDA's authority to 
    make these determinations is found at section 801(a) of the act (21 
    U.S.C. 381(a)).
        Section 803(b) of the act (21 U.S.C. 383(b)) provides FDA with 
    authority to enter into the medical device sectoral annex. That section 
    authorizes FDA to enter into agreements with foreign countries to 
    facilitate commerce in medical devices, consistent with the provisions 
    of the act. Such agreements are to encourage the mutual recognition of 
    GMP regulations relating to devices, as well as other regulations and 
    testing protocols determined by the Secretary (FDA by delegation) to be 
    appropriate.
        Additional support for FDA authority to enter into this MRA is 
    found in the PHS Act. Under section 307 of the PHS Act (42 U.S.C. 
    242l), the Secretary of Health and Human Services (FDA by delegation) 
    has authority ``to participate with other countries in cooperative 
    endeavors'' in biomedical research and health care technology. In 
    addition, the Secretary of Health and Human Services (FDA by 
    delegation) has authority under section 301 of the PHS Act (42 U.S.C. 
    241) to ``cooperate with, and render assistance to other appropriate 
    public authorities * * * in the conduct of * * * investigations * * * 
    relating to the * * * prevention of physical and mental diseases and 
    impairments of man * * * .'' The cooperative activities between FDA and 
    the EC set forth in the MRA and this proposed regulation, fall within 
    FDA's delegated authority under these sections of the PHS Act.
        Finally, a provision of the recently enacted FDAMA provides 
    authority for FDA to participate in MRA activities. Section 410 of 
    FDAMA authorizes FDA to ``support the Office of the United States Trade 
    Representative, in consultation with the Secretary of Commerce, in 
    efforts to move toward the acceptance of mutual recognition agreements 
    relating to the regulation of drugs, biological products, [and] devices 
    * * * and the regulation of good manufacturing practices, between the 
    European Union and the United States'' (Ref. 5). During negotiation of 
    this MRA, officials from FDA, the Office of the United States Trade 
    Representative, and the Department of Commerce participated in 
    activities in an effort to move toward acceptance of a mutual 
    recognition agreement.
    
    III. Environmental Impact
    
        The agency has determined under 21 CFR 25.30(h) that this action is 
    of a type that does not individually or cumulatively have a significant 
    effect on the human environment. Therefore, neither an environmental 
    assessment nor an environmental impact statement is required.
    
    IV. Analysis of Impacts
    
        FDA has examined the impacts of the proposed rule under Executive 
    Order 12866, under the Regulatory Flexibility Act (Pub. L. 96-354, as 
    amended by Pub. L. 104-121), and under the Unfunded Mandates Reform Act 
    (Pub. L. 104-4). Executive Order 12866 directs agencies to assess all 
    costs and benefits of available regulatory alternatives and, when 
    regulation is necessary, to select regulatory approaches that maximize 
    net benefits (including potential economic, environmental, public 
    health and safety, and other advantages; distributive impacts; and 
    equity). The Regulatory Flexibility Act requires agencies to analyze 
    regulatory options that would minimize any significant impact of a rule 
    on small entities. The Unfunded Mandates Reform Act requires agencies 
    to prepare an assessment of anticipated costs and benefits before 
    enacting any rule that may result in an expenditure by State, local and 
    tribal governments, in the aggregate, or by the private sector, of 
    $100,000,000 (adjusted annually for inflation) in any one year.
        The agency believes that this proposed rule is consistent with the 
    regulatory philosophy and principles identified in the Executive Order 
    and in these two statutes. Through this regulation, the agency is 
    proposing to set out requirements through which it may normally endorse 
    certain conformity assessment procedure reports. Such reports would be 
    provided by equivalent EC Member State regulatory authorities for 
    manufacturing site inspections to ascertain conformity with 
    pharmaceutical GMP's and by equivalent conformity assessment bodies for 
    quality system audits and certain medical device premarket evaluations. 
    Obtaining conformity assessment information in the manner described in 
    the proposed rule is inherently more efficient and cost-effective than 
    the existing approach, where additional inspection efforts by FDA in 
    foreign countries are necessary because foreign regulatory systems have 
    not been found equivalent. The primary benefit of the proposed rule is 
    to provide credible assurance that the rapidly increasing volume of EC 
    Member States' imports into the United States meet pharmaceutical GMP 
    requirements, and medical device quality system evaluation and certain 
    premarket evaluation requirements, as specified in U.S. statutes and 
    regulations. In the future, this credible assurance must be achievable 
    without resource expenditures by FDA that are directly proportional to 
    the volume of trade.
        In recent years, the credibility of the current approach has been 
    strained as FDA's essentially constant foreign inspection capacity has 
    been stretched over an expanding volume of imports from the EC. In the 
    3-year interval between 1994 and 1997, the value of EC pharmaceutical 
    and medical device imports into the United States has nearly doubled 
    from $5.5 billion to more than $10.7 billion. Growth has been greatest 
    in pharmaceuticals, where
    
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    annual EC exports have increased by more than $2 billion in each of the 
    last 2 years. In 1997, FDA conducted one inspection in the EC for every 
    $60 million in pharmaceutical exports to the United States, which is 
    less than half the coverage intensity of 1994. In addition, the 
    majority of these inspections have been preapproval in nature. 
    Continuation of the current trend will further decrease FDA's coverage 
    intensity to less than one inspection per $100 million in EC 
    pharmaceutical exports by the year 2000. Equivalence with EC Member 
    State regulatory systems has the potential for leveraging FDA's 
    regulatory resources so that necessary conformity assessments can be 
    ensured for higher volumes of future trade.
        In addition to coping with higher trade volumes, mutual recognition 
    or equivalence-based agreements with exporting nations may permit FDA 
    to redirect some of its inspectional resources to risk priorities not 
    covered by such agreements. This flexibility would provide a more 
    responsive level of U.S. consumer protection in the face of a changing 
    global marketplace with inherently variable risk management priorities.
        Another important benefit of the proposed rule would be the cost 
    savings realized by the regulated industry, largely as a result of 
    sharing inspection reports among equivalent regulatory authorities. 
    This exchange, in turn, will eliminate the need for duplicative 
    inspections and permit individual firms to undergo fewer inspections of 
    manufacturing sites. FDA does not have data on the average 
    administrative cost incurred by pharmaceutical (including biological) 
    or medical device manufacturers as they participate in regulatory 
    inspections, but it is reasonable to assume that the avoidance of 
    redundant inspections would generate cost savings. The proposed rule 
    also may shorten product review times for regulated products as a 
    result of the increased efficiency of premarket approval inspection 
    activities and the third-party evaluation of certain medical devices. 
    Quantification of this savings will be highly dependent on the specific 
    countries that achieve equivalence and the number of medical device 
    audits and evaluations performed by conformity assessment bodies.
        The costs of this regulation appear to impact more directly on 
    governmental regulatory agencies than on the regulated industry. These 
    governmental costs involve both startup and operational components. FDA 
    has not received additional government funding earmarked for achieving 
    mutual recognition agreements. FDA, therefore, must proceed to 
    implement these agreements as a concurrent function within normal day-
    to-day regulatory activities. The 3-year transition period reflects the 
    necessity to absorb these startup costs within existing regulatory 
    budgets. Some activities such as joint inspections may be reasonably 
    easy to absorb as concurrent functions that do not require additional 
    funding, while others such as developing and maintaining systems for 
    routine information exchange may involve new activities. These absorbed 
    governmental costs will fall heavily on FDA, as it must assess 
    equivalence of multiple EC Member States and notified bodies.
        For FDA, the absorption of these startup costs will be easier with 
    respect to those EC Member States with a large volume of trade, where 
    FDA already conducts enough inspections to gather a general 
    understanding of the requirements and regulatory practices of the 
    exporting country. From this perspective, the pace and priorities for 
    mutual recognition agreements during the transition period may be 
    dictated by FDA's ability to conduct these processes as concurrent 
    functions within current activities.
        In the longer run, an operational system of mutual recognition 
    agreements could pose additional costs on regulatory authorities of 
    exporting countries if equivalence requires a frequency, focus or 
    content of inspections not presently included in regulatory 
    requirements of the exporting nation. For example, Country A may not be 
    able to provide the frequency of medical device inspections desired by 
    Country B without conducting inspections beyond those required for 
    Country A's domestic inspection strategy. Conversely, Country B may not 
    be able to provide to Country A adequate details of the quality of 
    pharmaceutical source materials, because Country B does not have 
    inspectional authority over pharmaceutical starting materials. To the 
    extent such costs are insignificant or offset by other savings, they 
    will not likely be obstacles to reaching agreement on equivalence.
        This proposal is not expected to involve any new incremental costs 
    to the affected industry. Although joint inspections during the 
    transition period may create the appearance of more regulatory effort, 
    they should not impose additional costs on the firms inspected. FDA 
    does not anticipate an increase in the total number of inspections, and 
    in fact, the coverage intensity of FDA inspections in the EC would 
    continue to fall during the transition period, as it has been for the 
    past several years. Other activities related to equivalence 
    determinations, such as the procedures for exchanging information and 
    reports, focus on the interface and coordination between regulatory 
    agencies and, as such, do not affect industry in a cost context.
        The Regulatory Flexibility Act requires agencies to analyze 
    regulatory options that would minimize any significant impact of a rule 
    on small entities unless the rule is not expected to have a significant 
    impact on a substantial number of small entities. As the proposed 
    regulation is not expected to impose costs on the regulated industry, 
    the agency certifies that the proposed rule would not have a 
    significant impact on a substantial number of small entities. 
    Therefore, under the Regulatory Flexibility Act, no further analysis is 
    required.
        The Unfunded Mandates Act of 1995 requires that agencies prepare an 
    assessment of the anticipated costs and benefits before issuing any 
    final rule that may result in expenditures by State, local, and tribal 
    governments, in the aggregate, or by the private sector, of 
    $100,000,000 or more (adjusted annually for inflation) in any one year. 
    This proposed rule does not impose any mandates on State, local or 
    tribal governments, or the private sector that would result in an 
    annual expenditure of $100,000,000 or more. Therefore, no further 
    analysis is appropriate for this requirement.
    
    V. Paperwork Reduction Act of 1995
    
        This proposed rule does not contain any information collection 
    provisions that would be subject to review by the Office of Management 
    and Budget (OMB) under the Paperwork Reduction Act of 1995 (44 U.S.C. 
    3501-3520).
    
    VI. Request for Comments
    
        Interested persons may, on or before May 11, 1998, submit to the 
    Dockets Management Branch (address above) written comments regarding 
    this proposed regulation. Comments must be received by the Dockets 
    Management Branch by 4:30 p.m. Eastern Standard Time May 11, 1998. Two 
    copies of any comments are to be submitted, except that individuals may 
    submit one copy. Comments are to be identified with the docket number 
    found in brackets in the heading of this document. Received comments, a 
    copy of the MRA, and a summary explanation of the MRA's provisions, to 
    aid in commenting, may be seen in the office above between 9 a.m. and 4 
    p.m., Monday through Friday. In addition, an electronic copy of the MRA 
    and the summary
    
    [[Page 17747]]
    
    explanation is available on FDA's web site at ``http://www.fda.gov'' 
    under the ``international'' heading menu item.
        The comment period in this document is shorter than the 60 days FDA 
    customarily provides for proposed rules (21 CFR 10.40(b)(2)). FDA 
    believes it is unnecessary to provide 60 days for comment, given the 
    opportunities for public comment the agency already has provided. 
    During the course of the negotiations of the MRA, FDA provided a number 
    of opportunities for public discussion. For example, on May 9, 1996 (61 
    FR 21194), FDA established a public docket for information concerning 
    the MRA (Ref. 6). In addition, on October 18, 1996, FDA made available 
    for public comment copies of a document entitled, ``FDA Proposal for an 
    Agreement With the European Union Concerning the Mutual Recognition of 
    Inspections to Determine Adherence to Manufacturing Practices for 
    Pharmaceuticals Including Biologicals.'' FDA formally sought public 
    comment on this proposal through a Federal Register notice (61 FR 
    54448, October 18, 1996). To provide opportunity for public input into 
    the pharmaceutical GMP discussions with the European Commission, FDA 
    hosted public exchange meetings in Washington, DC, and Rockville, MD, 
    on March 31, 1995 (see 60 FR 15934, March 28, 1995), and October 30, 
    1996 (see 61 FR 54448, October 18, 1996). On November 8 and 9, 1996, a 
    transatlantic business dialogue (TABD) meeting included an extensive 
    discussion of the unresolved issues for the pharmaceutical and medical 
    device annexes to the MRA (Ref. 7), and on March 14, 1997, FDA 
    participated in a meeting of U.S. agencies and nongovernmental 
    organizations, which included several consumer, industry, and 
    environmental groups. Finally, FDA provided information and solicited 
    comment on the MRA at a September 23, 1997, National Consumer Forum 
    held in Washington, DC. The purpose of the forum was to facilitate 
    dialogue on the MRA between FDA and consumers.
        In light of the extensive opportunities for public participation, 
    FDA believes there is good cause to provide 30 days for comment on this 
    proposed rule. The agency also believes it is in the public interest to 
    proceed expeditiously to implement the MRA, so that it can proceed 
    toward the anticipated resource efficiencies and enhancement of product 
    safety, effectiveness, and quality that the MRA can provide. The 30-day 
    comment period provides sufficient opportunity to receive and consider 
    comments before the anticipated signing of the MRA in late spring or 
    early summer.
        The agency also notes that the comment period is less than that 
    required by Executive Order 12889 (58 FR 69681, December 30, 1993). 
    Section 4 of Executive Order 12889 states that any agency subject to 
    the Administrative Procedure Act shall provide a 75-day comment period 
    for any proposed technical regulation. Because this proposed rule 
    creates no new technical obligations or mandatory requirements on the 
    public, FDA believes that it is not a technical regulation subject to 
    Section 4 of Executive Order 12889. As a result, a 75-day comment 
    period is not required for this proposed rule.
    
    VII. References
    
        1. The European Community consists of the following member 
    States: Austria, Belgium, Denmark, Finland, France, Germany, Greece, 
    Ireland, Italy, Luxembourg, The Netherlands, Portugal, Spain, 
    Sweden, and the United Kingdom. These countries have vested in the 
    European Commission the authority to conduct certain international 
    negotiations, on their behalf, with other countries such as the 
    United States.
        2. On June 20, 1997, U.S. Trade Representative Charlene 
    Barshefsky and European Commission Vice President Leon Brittan 
    signed ``Agreed Minutes on the Agreement on Mutual Recognition 
    between the United States of America and the European Community,'' 
    which states that the MRA ``represents the text we commit to submit 
    to our respective authorities with a view to completing the 
    necessary procedures for approval and implementation.'' The complete 
    text of the MRA is available on the Internet at FDA's web site, 
    ``http://www.fda.gov'', under the ``international'' menu item or on 
    the European Community web site, ``http://europa.eu.int/en/comm/
    dg01/mra03.htm''.
        3. Food and Drug Administration Modernization Act of 1997 
    (FDAMA), section 417, Pub. L. 105-115, 111 Stat. 2296 (1997) (to be 
    codified at 21 U.S.C. 360(i)(3)).
        4. Provisions in the act that govern FDA regulation of 
    pharmaceuticals and medical devices include sections 501, 502, 505, 
    512, 513, 520, and 522 (21 U.S.C. 351, 352, 355, 360b, 360c, 360j, 
    and 360l).
        5. FDAMA section 410 (to be codified at 21 U.S.C. 383(c)(2)).
        6. Information in the docket includes summaries of minutes of 
    the meetings described in this document with written comments 
    received from interested parties, summaries of the various 
    negotiation sessions between FDA and the European Commission and EC 
    Member State representatives, and copies of draft agreements 
    covering pharmaceutical GMP's and medical devices that were 
    exchanged between the EC and FDA in December 1996 and January 1997.
        7. The TABD is an industry-driven initiative that aims to 
    facilitate closer economic relations between the EC and the United 
    States.
    
    VIII. Comparison Table
    
        The following table shows the relationship of the MRA Articles and 
    the sections of the Code of Federal Regulations (CFR) as proposed under 
    this rule:
    
        Table 1.--Relationship of the MRA Articles to sections in the CFR   
    ------------------------------------------------------------------------
                    MRA Article                          CFR Section        
    ------------------------------------------------------------------------
      Sectoral Annex for Pharmaceutical GMP's              Subpart A        
    ------------------------------------------------------------------------
    Article 1.................................  26.1                        
    Article 2.................................  26.2                        
    Article 3.................................  26.3                        
    Article 4.................................  26.4                        
    Article 5.................................  26.5                        
    Article 6.................................  26.6                        
    Article 7.................................  26.7                        
    Article 8.................................  26.8                        
    Article 9.................................  26.9                        
    Article 10................................  26.10                       
    Article 11................................  26.11                       
    Article 12................................  26.12                       
    Article 13................................  26.13                       
    Article 14................................  26.14                       
    Article 15................................  26.15                       
    Article 16................................  26.16                       
    Article 17................................  26.17                       
    Article 18................................  26.18                       
    Article 19................................  26.19                       
    Article 20................................  26.20                       
    Article 21................................  26.21                       
    Appendix 1................................  Appendix A                  
    Appendix 2................................  Appendix B                  
    Appendix 3................................  Appendix C                  
    Appendix 4................................  Appendix D                  
    Appendix 5................................  Appendix E                  
    ------------------------------------------------------------------------
    
    
                                                                            
    ------------------------------------------------------------------------
                    MRA Article                          CFR Section        
    ------------------------------------------------------------------------
         Sectoral Annex on Medical Devices                Subpart B         
    ------------------------------------------------------------------------
    Article 1.................................  26.31                       
    Article 2.................................  26.32                       
    Article 3.................................  26.33                       
    Article 4.................................  26.34                       
    Article 5.................................  26.35                       
    Article 6.................................  26.36                       
    Article 7.................................  26.37                       
    Article 8.................................  26.38                       
    Article 9.................................  26.39                       
    Article 10................................  26.40                       
    Article 11................................  26.41                       
    Article 12................................  26.42                       
    Article 13................................  26.43                       
    Article 14................................  26.44                       
    Article 15................................  26.45                       
    Article 16................................  26.46                       
    Article 17................................  26.47                       
    Article 18................................  26.48                       
    Article 19................................  26.49                       
    Article 20................................  26.50                       
    Appendix 1................................  Appendix A                  
    
    [[Page 17748]]
    
                                                                            
    Appendix 2 and Tables 1-3.................  Appendix B and Tables 1-3   
    Appendix 3 [Reserved].....................  Appendix C [Reserved]       
    Appendix 4 [Reserved].....................  Appendix D [Reserved]       
    Appendix 5 [Reserved].....................  Appendix E [Reserved]       
    Appendix 6 [Reserved].....................  Appendix F [Reserved]       
    ------------------------------------------------------------------------
    
    
                                                                            
    ------------------------------------------------------------------------
                    MRA Article                          CFR Section        
    ------------------------------------------------------------------------
                Umbrella Agreement                        Subpart C         
    ------------------------------------------------------------------------
    Article 1.................................  26.60                       
    Article 2.................................  26.61                       
    Article 3.................................  26.62                       
    Article 4.................................  26.63                       
    Article 5.................................  26.64                       
    Article 6.................................  26.65                       
    Article 7.................................  26.66                       
    Article 8.................................  26.67                       
    Article 9.................................  26.68                       
    Article 10................................  26.69                       
    Article 11................................  26.70                       
    Article 12................................  26.71                       
    Article 13................................  26.72                       
    Article 14................................  26.73                       
    Article 15................................  26.74                       
    Article 16................................  26.75                       
    Article 17................................  26.76                       
    Article 18................................  26.77                       
    Article 19................................  26.78                       
    Article 20................................  26.79                       
    Article 21................................  26.80                       
    Article 22................................  26.81                       
    ------------------------------------------------------------------------
    
    List of Subjects in 21 CFR Part 26
    
        Animal and human drugs, Biologicals, Devices, Exports, Imports, 
    Incorporation by reference, and Inspections.
        Therefore, under the Federal Food, Drug, and Cosmetic Act and the 
    Public Health Service Act and under authority delegated to the 
    Commissioner of Food and Drugs, it is proposed that 21 CFR chapter I be 
    amended by adding part 26 to read as follows:
    
    PART 26--MUTUAL RECOGNITION OF PHARMACEUTICAL GOOD MANUFACTURING 
    PRACTICE REPORTS, MEDICAL DEVICE QUALITY SYSTEM AUDIT REPORTS, AND 
    CERTAIN MEDICAL DEVICE PREMARKET EVALUATION REPORTS PROVIDED BY 
    EUROPEAN COMMUNITY MEMBER STATE REGULATORY AUTHORITIES AND EUROPEAN 
    COMMUNITY CONFORMITY ASSESSMENT BODIES
    
    Sec.
    26.0 General.
    
    Subpart A--Specific Sector Provisions for Pharmaceutical Good 
    Manufacturing Practices
    
    26.1 Definitions.
    26.2 Purpose.
    26.3 Scope.
    26.4 Product coverage.
    26.5 Length of transition period.
    26.6 Equivalence assessment.
    26.7 Participation in the equivalence assessment and determination.
    26.8 Other transition activities.
    26.9 Equivalence determination.
    26.10 Regulatory authorities not listed as currently equivalent.
    26.11 Start of operational period.
    26.12 Nature of recognition of inspection reports.
    26.13 Transmission of postapproval inspection reports.
    26.14 Transmission of preapproval inspection reports.
    26.15 Monitoring continued equivalence.
    26.16 Suspension.
    26.17 Role and composition of the Joint Sectoral Committee.
    26.18 Regulatory collaboration.
    26.19 Information relating to quality aspects.
    26.20 Alert system.
    26.21 Safeguard clause.
    Appendix A of Subpart A--List of Applicable Laws, Regulations, and 
    Administrative provisions.
    Appendix B of Subpart A--List of Authorities.
    Appendix C of Subpart A--Indicative List of Products Covered by 
    Subpart A.
    Appendix D of Subpart A--Criteria for Assessing Equivalence for 
    Post- and Preapproval.
    Appendix E of Subpart A--Elements to be Considered in Developing a 
    Two-way Alert System.
    
    Subpart B--Specific Sector Provisions for Medical Devices
    
    26.31 Purpose.
    26.32 Scope.
    26.33 Product coverage.
    26.34 Regulatory authorities.
    26.35 Length and purpose of transition period.
    26.36 Listing of CAB's.
    26.37 Confidence building activities.
    26.38 Other transition period activities.
    26.39 Equivalence assessment.
    26.40 Start of the operational period.
    26.41 Exchange and endorsement of quality system evaluation reports.
    26.42 Exchange and endorsement of product evaluation reports.
    26.43 Transmission of quality system evaluation reports.
    26.44 Transmission of product evaluation reports.
    26.45 Monitoring continued equivalence.
    26.46 Listing of additional CAB's.
    26.47 Role and composition of the Joint Sectoral Committee.
    26.48 Harmonization.
    26.49 Regulatory cooperation.
    26.50 Alert system and exchange of postmarket vigilance reports.
    Appendix A of Subpart B--Relevant Legislation, Regulations and 
    Procedures
    Appendix B of Subpart B--Scope of Product Coverage
    Appendix C of Subpart B [Reserved]
    Appendix D of Subpart B [Reserved]
    Appendix E of Subpart B [Reserved]
    Appendix F of Subpart B [Reserved]
    
    Subpart C--Framework or ``Umbrella'' Provisions
    
    26.60 Definitions.
    26.61 Purpose of this part.
    26.62 General obligations.
    26.63 General coverage of this part.
    26.64 Transitional arrangements.
    26.65 Designating authorities.
    26.66 Designation and listing procedures.
    26.67 Suspension of listed conformity assessment bodies.
    26.68 Withdrawal of listed conformity assessment bodies.
    26.69 Monitoring of conformity assessment bodies.
    26.70 Conformity assessment bodies.
    26.71 Exchange of information.
    26.72 Sectoral contact points.
    26.73 Joint Committee.
    26.74 Preservation of regulatory authority.
    26.75 Suspension of recognition obligations.
    26.76 Confidentiality.
    26.77 Fees.
    26.78 Agreements with other countries.
    26.79 Territorial application.
    26.80 Entry into force, amendment and termination.
    26.81 Final provisions.
        Authority: 15 U.S.C. 1453, 1454, 1455; 21 U.S.C. 321, 343, 351, 
    352, 355, 360, 360b, 360c, 360d, 360e, 360f, 360g, 360h, 360i, 360j, 
    360l, 371, 374, 381, 382, 383, 393; 42 U.S.C. 216, 241, 242l, 262, 
    264, 265.
    
    Sec. 26.0  General.
    
        This part substantially reflects relevant provisions of the 
    proposed international agreement entitled, ``Agreement on Mutual 
    Recognition Between the United States of America and the European 
    Community'' (the MRA), including the ``umbrella'' text and its sectoral 
    annexes on pharmaceutical good manufacturing practices (GMP's) and 
    medical devices. Whereas the parties to the MRA would be the United 
    States and the European Community (EC), this part is relevant only to 
    the Food and Drug Administration's (FDA's) implementation of the MRA 
    and the
    
    [[Page 17749]]
    
    sectoral annexes cited in this section. For codification purposes, 
    certain provisions of the MRA have been modified for use in this part. 
    This modification is done for purposes of clarity only and shall not 
    affect the text of the MRA to be concluded between the United States 
    and the EC, or the rights and obligations of the United States or EC 
    under that agreement. References to the terms ``party'' or ``parties'' 
    reflect FDA's proposed implementation of the MRA and its sectoral 
    annexes. It is understood that the EC will also be a party to the MRA 
    and that it will implement the MRA in accordance with its internal 
    procedures. If the parties to the MRA subsequently amend or terminate 
    the MRA, FDA will modify this part accordingly, using appropriate 
    administrative procedures.
    
    Subpart A--Specific Sector Provisions for Pharmaceutical Good 
    Manufacturing Practices
    
    
    Sec. 26.1  Definitions.
    
        (a) Enforcement means action taken by an authority to protect the 
    public from products of suspect quality, safety, and efficacy or to 
    assure that products are manufactured in compliance with appropriate 
    laws, regulations, standards, and commitments made as part of the 
    approval to market a product.
        (b) Equivalence of the regulatory systems means that the systems 
    are sufficiently comparable to assure that the process of inspection 
    and the ensuing inspection reports will provide adequate information to 
    determine whether respective statutory and regulatory requirements of 
    the authorities have been fulfilled. Equivalence does not require that 
    the respective regulatory systems have identical procedures.
        (c) Good Manufacturing Practices (GMP's): [These GMP conceptual 
    definitions are to be merged by the parties at a future date.]
        (1) GMP's mean the requirements found in the respective 
    legislations, regulations, and administrative provisions for methods to 
    be used in, and the facilities or controls to be used for, the 
    manufacturing, processing, packing, and/or holding of a drug to assure 
    that such drug meets the requirements as to safety, and has the 
    identity and strength, and meets the quality and purity characteristics 
    that it purports or is represented to possess.
        (2) GMP's are that part of quality assurance which ensures that 
    products are consistently produced and controlled to quality standards. 
    For the purpose of this subpart, GMP's include, therefore, the system 
    whereby the manufacturer receives the specifications of the product 
    and/or process from the marketing authorization/product authorization 
    or license holder or applicant and ensures the product is made in 
    compliance with its specifications (qualified person certification in 
    the European Community (EC)).
         (d) Inspection means an onsite evaluation of a manufacturing 
    facility to determine whether such manufacturing facility is operating 
    in compliance with GMP's and/or commitments made as part of the 
    approval to market a product.
         (e) Inspection Report means the written observations and GMP's 
    compliance assessment completed by an authority listed in Appendix B of 
    this subpart.
         (f) Regulatory System means the body of legal requirements for 
    GMP's, inspections, and enforcements that ensure public health 
    protection and legal authority to assure adherence to these 
    requirements.
    
    
    Sec. 26.2  Purpose.
    
        The provisions of this subpart govern the exchange between the 
    parties and normal endorsement by the receiving regulatory authority of 
    official good manufacturing practice (GMP) inspection reports after a 
    transitional period aimed at determination of the equivalence of the 
    regulatory systems of the parties, which is the cornerstone of this 
    subpart.
    
    
    Sec. 26.3  Scope.
    
        (a) The provisions of this subpart shall apply to pharmaceutical 
    inspections carried out in the United States and Member States of the 
    European Community (EC) before products are marketed (hereafter 
    referred to as ``preapproval inspections'') as well as during their 
    marketing (hereafter referred to as ``postapproval inspections'').
        (b) Appendix A of this subpart names the laws, regulations, and 
    administrative provisions governing these inspections and the good 
    manufacturing practice (GMP) requirements.
        (c) Appendix B of this subpart lists the authorities participating 
    in activities under this subpart.
        (d) Sections 26.65, 26.66, 26.67, 26.68, 26.69, and 26.70 of 
    subpart C of this part do not apply to this subpart.
    
    
    Sec. 26.4  Product coverage.
    
        (a) These provisions will apply to medicinal products for human or 
    animal use, intermediates and starting materials (as referred to in the 
    European Community (EC)) and to drugs for human or animal use, 
    biological products for human use, and active pharmaceutical 
    ingredients (as referred to in the United States), only to the extent 
    they are regulated by the authorities of both parties as listed in 
    Appendix B of this subpart.
        (b) Human blood, human plasma, human tissues and organs, and 
    veterinary immunologicals (under 9 CFR 101.2, ``veterinary 
    immunologicals'' are referred to as ``veterinary biologicals'') are 
    excluded from the scope of this subpart. Human plasma derivatives (such 
    as immunoglobulins and albumin), investigational medicinal products/new 
    drugs, human radiopharmaceuticals, and medicinal gases are also 
    excluded during the transition phase, their situation will be 
    reconsidered at the end of the transition period. Products regulated by 
    FDA's Center for Biologics Evaluation and Research as devices are not 
    covered under this subpart.
        (c) Appendix C of this subpart contains an indicative list of 
    products covered by this subpart.
    
    
    Sec. 26.5  Length of transition period.
    
        A 3-year transition period will start immediately after the 
    effective date described in Sec. 26.80(a).
    
    
    Sec. 26.6  Equivalence assessment.
    
        (a) The criteria to be used by the parties to assess equivalence 
    are listed in Appendix D of this subpart. Information pertaining to the 
    criteria under European Community (EC) competence will be provided by 
    the EC.
        (b) The authorities of the parties will establish and communicate 
    to each other their draft programs for assessing the equivalence of the 
    respective regulatory systems in terms of quality assurance of the 
    products and consumer protection. These programs will be carried out, 
    as deemed necessary by the regulatory authorities, for post- and 
    preapproval inspections and for various product classes or processes.
        (c) The equivalence assessment shall include information exchanges 
    (including inspection reports), joint training, and joint inspections 
    for the purpose of assessing regulatory systems and the authorities' 
    capabilities. In conducting the equivalence assessment, the parties 
    will ensure that efforts are made to save resources.
        (d) Equivalence assessment for authorities added to Appendix B of 
    this subpart after the effective date of this part as described in 
    Sec. 26.80(a) will be conducted as described in this subpart, as soon 
    as practicable.
    
    [[Page 17750]]
    
    Sec. 26.7  Participation in the equivalence assessment and 
    determination.
    
        The authorities listed in Appendix B of this subpart will actively 
    participate in these programs to build a sufficient body of evidence 
    for their equivalence determination. Both parties will exercise good 
    faith efforts to complete equivalence assessment as expeditiously as 
    possible to the extent the resources of the authorities allow.
    
    
    Sec. 26.8  Other transition activities.
    
        As soon as possible, the authorities will jointly determine the 
    essential information which must be present in inspection reports and 
    will cooperate to develop mutually agreed inspection report format(s).
    
    
    Sec. 26.9  Equivalence determination.
    
        (a) Equivalence is established by having in place regulatory 
    systems covering the criteria referred to in Appendix D of this 
    subpart, and a demonstrated pattern of consistent performance in 
    accordance with these criteria. A list of authorities determined as 
    equivalent shall be agreed to by the Joint Sectoral Committee at the 
    end of the transition period, with reference to any limitation in terms 
    of inspection type (e.g., postapproval or preapproval) or product 
    classes or processes.
        (b) The parties will document insufficient evidence of equivalence, 
    lack of opportunity to assess equivalence or a determination of 
    nonequivalence, in sufficient detail to allow the authority being 
    assessed to know how to attain equivalence.
    
    
    Sec. 26.10   Regulatory authorities not listed as currently equivalent.
    
        Authorities not currently listed as equivalent, or not equivalent 
    for certain types of inspections, product classes or processes may 
    apply for reconsideration of their status once the necessary corrective 
    measures have been taken or additional experience is gained.
    
    
    Sec. 26.11   Start of operational period.
    
        (a) The operational period shall start at the end of the transition 
    period and its provisions apply to inspection reports generated by 
    authorities listed as equivalent for the inspections performed in their 
    territory.
        (b) In addition, when an authority is not listed as equivalent 
    based on adequate experience gained during the transition period, FDA 
    will accept for normal endorsement (as provided in Sec. 26.12) 
    inspection reports generated as a result of inspections conducted 
    jointly by that authority on its territory and another authority listed 
    as equivalent, provided that the authority of the Member State in which 
    the inspection is performed can guarantee enforcement of the findings 
    of the inspection report and require that corrective measures be taken 
    when necessary. FDA has the option to participate in these inspections, 
    and based on experience gained during the transition period, the 
    parties will agree on procedures for exercising this option.
        (c) In the European Community (EC), the qualified person will be 
    relieved of responsibility for carrying the controls laid down in 
    Article 22 paragraph 1(b) of Council Directive 75/319/EEC (see Appendix 
    A of this subpart) provided that these controls have been carried out 
    in the United States and that each batch/lot is accompanied by a batch 
    certificate (in accordance with the World Health Organization 
    Certification Scheme on the Quality of Medicinal Products) issued by 
    the manufacturer certifying that the product complies with requirements 
    of the marketing authorization and signed by the person responsible for 
    releasing the batch/lot.
    
    
    Sec. 26.12  Nature of recognition of inspection reports.
    
        (a) Inspection reports (containing information as established under 
    Sec. 26.8), including a good manufacturing practice (GMP) compliance 
    assessment, prepared by authorities listed as equivalent, will be 
    provided to the authority of the importing party. Based on the 
    determination of equivalence in light of the experience gained, these 
    inspection reports will normally be endorsed by the authority of the 
    importing party, except under specific and delineated circumstances. 
    Examples of such circumstances include indications of material 
    inconsistencies or inadequacies in an inspection report, quality 
    defects identified in the postmarket surveillance or other specific 
    evidence of serious concern in relation to product quality or consumer 
    safety. In such cases, the authority of the importing party may request 
    clarification from the authority of the exporting party which may lead 
    to a request for reinspection. The authorities will endeavor to respond 
    to requests for clarification in a timely manner.
        (b) Where divergence is not clarified in this process, an authority 
    of the importing country may carry out an inspection of the production 
    facility.
    
    
    Sec. 26.13  Transmission of postapproval inspection reports.
    
        Postapproval good manufacturing practice (GMP) inspection reports 
    concerning products covered by this subpart will be transmitted to the 
    authority of the importing country within 60 calendar days of the 
    request. Should a new inspection be needed, the inspection report will 
    be transmitted within 90 calendar days of the request.
    
    
    Sec. 26.14  Transmission of preapproval inspection reports.
    
        (a) A preliminary notification that an inspection may have to take 
    place will be made as soon as possible.
        (b) Within 15 calendar days, the relevant authority will 
    acknowledge receipt of the request and confirm its ability to carry out 
    the inspection. In the European Community (EC), requests will be sent 
    directly to the relevant authority, with a copy to the European Agency 
    for the Evaluation of Medicinal Products (EMEA). If the authority 
    receiving the request cannot carry out the inspection as requested, the 
    requesting authority shall have the right to conduct the inspection.
        (c) Reports of preapproval inspections will be sent within 45 
    calendar days of the request that transmitted the appropriate 
    information and detailed the precise issues to be addressed during the 
    inspection. A shorter time may be necessary in exceptional cases and 
    these will be described in the request.
    
    
    Sec. 26.15   Monitoring continued equivalence.
    
        Monitoring activities for the purpose of maintaining equivalence 
    shall include review of the exchange of inspection reports and their 
    quality and timeliness; performance of a limited number of joint 
    inspections; and the conduct of common training sessions.
    
    
    Sec. 26.16   Suspension.
    
        (a) Each party has the right to contest the equivalence of a 
    regulatory authority. This right will be exercised in an objective and 
    reasoned manner in writing to the other party.
        (b) The issue shall be discussed in the Joint Sectoral Committee 
    promptly upon such notification. Where the Joint Sectoral Committee 
    determines that verification of equivalence is required, it may be 
    carried out jointly by the parties in a timely manner, under Sec. 26.6.
        (c) Efforts will be made by the Joint Sectoral Committee to reach 
    unanimous consent on the appropriate action. If agreement to suspend is 
    reached in the Joint Sectoral Committee, an authority may be suspended 
    immediately thereafter. If no agreement is reached in the Joint 
    Sectoral Committee, the matter is referred to the Joint Committee as 
    described in Sec. 26.73. If no unanimous consent is reached within 30 
    days after such notification, the contested authority will be 
    suspended.
        (d) Upon the suspension of authority previously listed as 
    equivalent, a party
    
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    is no longer obligated to normally endorse the inspection reports of 
    the suspended authority. A party shall continue to normally endorse the 
    inspection reports of that authority prior to suspension, unless the 
    authority of the receiving party decides otherwise based on health or 
    safety considerations. The suspension will remain in effect until 
    unanimous consent has been reached by the parties on the future status 
    of that authority.
    
    
    Sec. 26.17  Role and composition of the Joint Sectoral Committee.
    
        (a) A Joint Sectoral Committee is set up to monitor the activities 
    under both the transitional and operational phases of this subpart.
        (b) The Joint Sectoral Committee will be cochaired by a 
    representative of FDA for the United States and a representative of the 
    European Community (EC) who each will have one vote. Decisions will be 
    taken by unanimous consent.
        (c) The Joint Sectoral Committee's functions will include:
        (1) Making a joint assessment, which must be agreed by both 
    parties, of the equivalence of the respective authorities;
        (2) Developing and maintaining the list of equivalent authorities, 
    including any limitation in terms of inspecting type or products, and 
    communicating the list to all authorities and the Joint Committee;
        (3) Providing a forum to discuss issues relating to this subpart, 
    including concerns that an authority may be no longer equivalent and 
    opportunity to review product coverage; and
        (4) Consideration of the issue of suspension.
        (d) The Joint Sectoral Committee shall meet at the request of 
    either party and, unless the cochairs otherwise agree, at least once 
    each year. The Joint Committee will be kept informed of the agenda and 
    conclusions of meetings of the Joint Sectoral Committee.
    
    
    Sec. 26.18   Regulatory collaboration.
    
        (a) The parties and authorities shall inform and consult one 
    another, as permitted by law, on proposals to introduce new controls or 
    to change existing technical regulations or inspection procedures and 
    to provide the opportunity to comment on such proposals.
        (b) The parties shall notify each other in writing of any changes 
    to Appendix B of this subpart.
    
    
    Sec. 26.19   Information relating to quality aspects.
    
        The authorities will establish an appropriate means of exchanging 
    information on any confirmed problem reports, corrective actions, 
    recalls, rejected import consignments and other regulatory and 
    enforcement problems for products subject to this subpart.
    
    
    Sec. 26.20  Alert system.
    
        (a) The details of an alert system will be developed during the 
    transitional period. The system will be maintained in place at all 
    times. Elements to be considered in developing such a system are 
    described in Appendix E of this subpart.
        (b) Contact points will be agreed between both parties to permit 
    authorities to be made aware with the appropriate speed in case of 
    quality defect, recalls, counterfeiting, and other problems concerning 
    quality, which could necessitate additional controls or suspension of 
    the distribution of the product.
    
    
    Sec. 26.21  Safeguard clause.
    
        Each party recognizes that the importing country has a right to 
    fulfill its legal responsibilities by taking actions necessary to 
    ensure the protection of human and animal health at the level of 
    protection it deems appropriate. This includes the suspension of the 
    distribution, product detention at the border of the importing country, 
    withdrawal of the batches and any request for additional information or 
    inspection as provided in Sec. 26.12.
    
    Appendix A of Subpart A--List of Applicable Laws, Regulations, and 
    Administrative Provisions
    
    1. For the European Community:
    
        [Copies of EC documents may be obtained from the European 
    Document Research, 1100 17th St. NW., suite 301, Washington, DC 
    20036. EC documents may be viewed on the European Commission 
    Pharmaceuticals Units web site at ``http://dg3.eudra.org.'']
    Council Directive 65/65/EEC of 26 January 1965 on the approximation 
    of provisions laid down by law, regulation, or administrative action 
    relating to proprietary medicinal products as extended, widened, and 
    amended.
    Council Directive 75/319/EEC of 20 May 1975 on the approximation of 
    provisions laid down by law, regulation or administrative action 
    relating to proprietary medicinal products as extended, widened and 
    amended.
    Council Directive 81/851/EEC of 6 November 1981 on the approximation 
    of the laws of the Member States relating to veterinary medicinal 
    products as widened and amended.
    Commission Directive 91/356/EEC of 13 June 1991 laying down the 
    principles and guidelines of good manufacturing practice for 
    medicinal products for human use.
    Commission Directive 91/412/EEC of 23 July 1991 laying down the 
    principles and guidelines of good manufacturing practice for 
    veterinary medicinal products.
    Council Regulation No (EEC) 2309/93 of 23 July 1993 laying down 
    Community procedures for the authorization and supervision of 
    medicinal products for human and veterinary use and establishing a 
    European Agency for the Evaluation of Medicinal Products.
    Council Directive 92/25/EEC of 31 March 1992 on the wholesale 
    distribution of medicinal products for human use & Guide to Good 
    Distribution Practice.
    Current version of the Guide to Good Manufacturing Practice, Rules 
    Governing Medicinal Products in the European Community, Volume IV.
    
    2. For the United States :
    
        [Copies of FDA documents may be obtained from the Government 
    Printing Office, 1510 H St. NW., Washington, DC 20005. FDA 
    documents, except the FDA Compliance Program Guidance Manual, may be 
    viewed on FDA's Internet web site at ``http://www.FDA.gov''.]
    Relevant sections of the United States Federal Food, Drug, and 
    Cosmetic Act and the United States Public Health Service Act.
    Relevant sections of Title 21, United States Code of Federal 
    Regulations (CFR) Parts 1-99, Parts 200-299, Parts 500-599, and 
    Parts 600-799.
    Relevant sections of the FDA Investigations Operations Manual, the 
    FDA Regulatory Procedures Manual, the FDA Compliance Policy Guidance 
    Manual, the FDA Compliance Program Guidance Manual, and other FDA 
    guidances.
    
    Appendix B of Subpart A--List of Authorities
    
    1. For the United States:
    
    In the United States, the regulatory authority is the Food and Drug 
    Administration.
    
    2. For the European Community:
    
    In the European Community, the regulatory authorities are the 
    following :
     Austria: Bundesministerium Fur Arbeit, Gesundheit, und Soziales, 
    Wien.
    Belgium: Ministerie van Sociale Zakem, Volksgezondheid en Leefmilieu 
    /Ministere des Affaires Sociales, Sante Publique et Environment/ 
    Algemeine Farmaceutische Inspectie, Inspection Generale de la 
    Pharmacie, Bruxelles, Brussel.
    Denmark: Laegemiddelstryelsen, (Danish Medicines Agency), Bronshoj.
    Finland: Laakelaittos/Lakemedelsverket (National Agency for 
    Medicines), Helsinki.
    France: Agence du Medicament, Direction de l'inspection et des 
    etablissements, Saint Denis. (Human). Agence Nationale du Medicament 
    Veterinaire, Fougeres (Veterinary).
    Germany: Bundesgesundheitsministerium, Bonn. Paul-Ehrlich Institut, 
    Langen (biologicals only). Zustandige Behorden der 16 Bundeslander: 
    Bayern, Berlin Brandenberg, Bremen, Hamburg, Hessen, Niedersachsen, 
    Nordrhein-Westfalen, Rheinland-Pfalz, Mecklenberg-Vorpommern, 
    Saarland, Sachsen, Sachsenanhalt, Schleswog-Holstein, Thuringen.
    Greece: Ministry of Health and Welfare, National Drug Organisation 
    (E.O.F.), Athens.
    Ireland: Irish Medicines Board, Dublin.
    
    [[Page 17752]]
    
    Italy: Ministero della Sanita, Dipartimento Farmaci e 
    Farmacovigilanza, Roma. (Human). Ministero della Sanita, 
    Dipartimento alimenti e nutrizione e sanita pubblica veterinaria - 
    Div. IX, Roma (Veterinary).
    Luxembourg: Direction de la Sante, Division de la Pharmacie et des 
    Medicaments, Luxembourg.
    The Netherlands: Staatstoezicht op de Volksgezondheid, Inspectie 
    voor de Gezondheidszorg, Rijswijk.
    Portugal: Instituto da Farmacia e do Medicamento (INFARMED), Lisboa.
    Spain: Ministerio Sanidad y Consumo, Subdireccion. General de 
    Control Farmaceutico, Madrid. (Human) Ministerio de Agricultura 
    Pesca y Alimentacion, Madrid, (Veterinary).
    Sweden: Lakemedelsverket (Medical Products Agency), Uppsala.
    United Kingdom: Medicines Control Agency, London. Veterinary 
    Medicines Directorate, Addlestone.
    European Union: European Commission, Brussels. European Agency for 
    the Evaluation of Medicinal Products (EMEA), London.
    
    Appendix C of Subpart A--Indicative List of Products Covered by Subpart 
    A
    
    Recognizing that precise definition of medicinal products and drugs 
    are to be found in the legislations referred to above, an indicative 
    list of products covered by this arrangement is given below:
        - human medicinal products including prescription and 
    nonprescription drugs;
        - human biologicals including vaccines, and immunologicals;
        - veterinary pharmaceuticals, including prescription and 
    nonprescription drugs, with the exclusion of veterinary 
    immunologicals (Under 9 CFR 101.2 ``veterinary immunologicals'' are 
    referred to as ``veterinary biologicals.'');
        - premixes for the preparation of veterinary medicated feeds 
    (EC), Type A medicated articles for the preparation of veterinary 
    medicated feeds (United States);
        - intermediate products and active pharmaceutical ingredients or 
    bulk pharmaceuticals (United States)/starting materials (EC).
    
    Appendix D of Subpart A--Criteria for Assessing Equivalence for Post- 
    and Preapproval
    
    I. Legal/Regulatory authority and structures and procedures providing 
    for post- and preapproval:
    
    A. Appropriate statutory mandate and jurisdiction.
    B. Ability to issue and update binding requirements on GMP's and 
    guidance documents.
    C. Authority to make inspections, review and copy documents, and to 
    take samples and collect other evidence.
    D. Ability to enforce requirements and to remove products found in 
    violation of such requirements from the market.
    E. Substantive current good manufacturing requirements.
    F. Accountability of the regulatory authority.
    G. Inventory of current products and manufacturers.
    H. System for maintaining or accessing inspection reports, samples 
    and other analytical data, and other firm/product information 
    relating to matters covered by subpart A of this part.
    
    II. Mechanisms in place to assure appropriate professional standards 
    and avoidance of conflicts of interest.
    
    III. Administration of the regulatory authority:
    
    A. Standards of education/qualification and training.
    B. Effective quality assurance systems measures to ensure adequate 
    job performance.
    C. Appropriate staffing and resources to enforce laws and 
    regulations.
    
    IV. Conduct of inspections:
    
    A. Adequate preinspection preparation, including appropriate 
    expertise of investigator/team, review of firm/product and 
    databases, and availability of appropriate inspection equipment.
    B. Adequate conduct of inspection, including statutory access to 
    facilities, effective response to refusals, depth and competence of 
    evaluation of operations, systems, and documentation; collection of 
    evidence; appropriate duration of inspection and completeness of 
    written report of observations to firm management.
    C. Adequate postinspection activities, including completeness of 
    inspectors' report, inspection report review where appropriate, and 
    conduct of followup inspections and other activities where 
    appropriate, assurance of preservation and retrieval of records.
    
    V. Execution of regulatory enforcement actions to achieve corrections, 
    designed to prevent future violations, and to remove products found in 
    violation of requirements from the market.
    
    VI. Effective use of surveillance systems:
    
    A. Sampling and analysis.
    B. Recall monitoring.
    C. Product defect reporting system.
    D. Routine surveillance inspections.
    E. Verification of approved manufacturing process changes to 
    marketing authorizations/approved applications.
    
    VII. Additional specific criteria for preapproval inspections:
    
    A. Satisfactory demonstration through a jointly developed and 
    administered training program and joint inspections to assess the 
    regulatory authorities' capabilities.
    B. Preinspection preparation includes the review of appropriate 
    records, including site plans and drug master file or similar 
    documentation to enable adequate inspections.
    C. Ability to verify chemistry, manufacturing, and control data 
    supporting an application is authentic and complete.
    D. Ability to assess and evaluate research and development data as 
    scientifically sound, especially transfer technology of pilot, scale 
    up and full scale production batches.
    E. Ability to verify conformity of the onsite processes and 
    procedures with those described in the application.
    F. Review and evaluate equipment installation, operational and 
    performance qualification data, and evaluate test method validation.
    
    Appendix E of Subpart A--Elements to be Considered in Developing a Two-
    way Alert System
    
    1. Documentation
    
    - Definition of a crisis/emergency and under what circumstances an 
    alert is required
    - Standard Operating Procedures (SOP's)
    - Mechanism of health hazards evaluation and classification
    - Language of communication and transmission of information
    
    2. Crisis Management System
    
    - Crisis analysis and communication mechanisms
    - Establishment of contact points
    - Reporting mechanisms
    
    3. Enforcement Procedures
    
    - Followup mechanisms
    - Corrective action procedures
    
    4. Quality Assurance System
    
    - Pharmacovigilance programme
    - Surveillance/monitoring of implementation of corrective action
    
    5. Contact Points
    
    For the purpose of subpart A of this part, the contact points for 
    the alert system will be:
    
    A. For the European Community:
    
    the Executive Director of the European Agency for the Evaluation of 
    Medicinal Products, 7, Westferry Circus, Canary Wharf, UK - London 
    E14 4HB, England. Telephone 44-171-418 8400, Fax 418 8416.
    
    B. For the United States :
    
    Division of Emergency and Investigational Operations (DEIO), Food 
    and Drug Administration, 5600 Fishers Lane, Rockville, MD 20857. 
    Telephone 301-443-1240, Fax 301-443-3757.
    
     Subpart B--Specific Sector Provisions for Medical Devices
    
    
    Sec. 26.31  Purpose.
    
        (a) The purpose of this subpart is to specify the conditions under 
    which a party will accept the results of quality system-related 
    evaluations and inspections and premarket evaluations of the other 
    party with regard to medical devices as conducted by listed conformity 
    assessment bodies (CAB's) and to provide for other related cooperative 
    activities.
        (b) This subpart is intended to evolve as programs and policies of 
    the parties evolve. The parties will review this subpart periodically, 
    in order to assess progress and identify potential enhancements to this 
    subpart as FDA and European Community (EC) policies evolve over time.
    
    
    Sec. 26.32  Scope.
    
        (a) The provisions of this subpart shall apply to the exchange and, 
    where appropriate, endorsement of the following types of reports from 
    conformity assessment bodies (CAB's) assessed to be equivalent:
    
    [[Page 17753]]
    
        (1) Under the U.S. system, surveillance/postmarket and initial/
    preapproval inspection reports;
        (2) Under the U.S. system, premarket (510(k)) product evaluation 
    reports;
        (3) Under the European Community (EC) system, quality system 
    evaluation reports; and
        (4) Under the EC system, EC type examination and verification 
    reports.
        (b) Appendix A of this subpart names the legislation, regulations, 
    and related procedures under which:
        (1) Products are regulated as medical devices by each party;
        (2) CAB's are designated and confirmed; and
        (3) These reports are prepared.
        (c) For purposes of this subpart, equivalence means that: CAB's in 
    the EC are capable of conducting product and quality systems 
    evaluations against U.S. regulatory requirements in a manner equivalent 
    to those conducted by FDA; and CAB's in the United States are capable 
    of conducting product and quality systems evaluations against EC 
    regulatory requirements in a manner equivalent to those conducted by EC 
    CAB's.
    
    
    Sec. 26.33  Product coverage.
    
        (a) There are three components to this subpart each covering a 
    discrete range of products:
        (1) Quality System Evaluations. U.S.-type surveillance/postmarket 
    and initial/preapproval inspection reports and European Community (EC)-
    type quality system evaluation reports will be exchanged with regard to 
    all products regulated under both U.S. and EC law as medical devices.
        (2) Product Evaluation. U.S.-type premarket (510(k)) product 
    evaluation reports and EC-type-testing reports will be exchanged only 
    with regard to those products classified under the U.S. system as Class 
    I/Class II-Tier 2 medical devices which are listed in Appendix B of 
    this subpart.
        (3) Postmarket Vigilance Reports. Postmarket vigilance reports will 
    be exchanged with regard to all products regulated under both U.S. and 
    EC law as medical devices.
        (b) Additional products and procedures may be made subject to this 
    subpart by agreement of the parties.
    
    
    Sec. 26.34  Regulatory authorities.
    
        The regulatory authorities shall have the responsibility of 
    implementing the provisions of this subpart, including the designation 
    and monitoring of conformity assessment bodies (CAB's). Regulatory 
    authorities will be specified in Appendix C of this subpart.. Each 
    party will promptly notify the other party in writing of any change in 
    the regulatory authority for a country.
    
    
    Sec. 26.35  Length and purpose of transition period.
    
        There will be a 3-year transition period immediately following the 
    date described in Sec. 26.80(a). During the transition period, the 
    parties will engage in confidence-building activities for the purpose 
    of obtaining sufficient evidence to make determinations concerning the 
    equivalence of conformity assessment bodies (CAB's) of the other party 
    with respect to the ability to perform quality system and product 
    evaluations or other reviews resulting in reports to be exchanged under 
    this subpart.
    
    
    Sec. 26.36  Listing of CAB's.
    
        Each party shall designate conformity assessment bodies (CAB's) to 
    participate in confidence-building activities by transmitting to the 
    other party a list of CAB's which meet the criteria for technical 
    competence and independence, as identified in Appendix A of this 
    subpart. The list shall be accompanied by supporting evidence. 
    Designated CAB's will be listed in Appendix D of this subpart for 
    participation in the confidence building activities once confirmed by 
    the importing party. Nonconfirmation would have to be justified based 
    on documented evidence.
    
    
    Sec. 26.37  Confidence building activities.
    
        (a) At the beginning of the transitional period, the Joint Sectoral 
    Group will establish a joint confidence building program calculated to 
    provide sufficient evidence of the capabilities of the designated 
    conformity assessment bodies (CAB's) to perform quality system or 
    product evaluations to the specifications of the parties.
        (b) The joint confidence building program should include the 
    following actions and activities:
        (1) Seminars designed to inform the parties and CAB's about each 
    party's regulatory system, procedures, and requirements;
        (2) Workshops designed to provide the parties with information 
    regarding requirements and procedures for the designation and 
    surveillance of CAB's;
        (3) Exchange of information about reports prepared during the 
    transition period;
        (4) Joint training exercises; and
        (5) Observed inspections.
        (c) During the transition period, any significant problem that is 
    identified with a CAB may be the subject of cooperative activities, as 
    resources allow and as agreed to by the regulatory authorities, aimed 
    at resolving the problem.
        (d) Both parties will exercise good faith efforts to complete the 
    confidence building activities as expeditiously as possible to the 
    extent that the resources of the parties allow.
        (e) Both the parties will each prepare annual progress reports 
    which will describe the confidence building activities undertaken 
    during each year of the transition period. The form and content of the 
    reports will be determined by the parties through the Joint Sectoral 
    Committee.
    
    
    Sec. 26.38  Other transition period activities.
    
        (a) During the transition period, the parties will jointly 
    determine the necessary information which must be present in quality 
    system and product evaluation reports.
        (b) The parties will jointly develop a notification and alert 
    system to be used in case of defects, recalls, and other problems 
    concerning product quality that could necessitate additional actions 
    (e.g., inspections by the parties of the importing country) or 
    suspension of the distribution of the product.
    
    
    Sec. 26.39  Equivalence assessment.
    
        (a) In the final 6 months of the transition period, the parties 
    shall proceed to a joint assessment of the equivalence of the 
    conformity assessment bodies (CAB's) that participated in the 
    confidence building activities. CAB's will be determined to be 
    equivalent provided they have demonstrated proficiency through the 
    submission of a sufficient number of adequate reports. CAB's may be 
    determined to be equivalent with regard to the ability to perform any 
    type of quality system or product evaluation covered by this subpart 
    and with regard to any type of product covered by this subpart. The 
    parties shall develop a list contained in Appendix E of this subpart of 
    CAB's determined to be equivalent which shall contain a full 
    explanation of the scope of the equivalency determination, including 
    any appropriate limitations, with regard to performing any type of 
    quality system or product evaluation.
        (b) The parties shall allow CAB's not listed for participation in 
    this subpart, or listed for participation only as to certain types of 
    evaluations, to apply for participation in this subpart once the 
    necessary measures have been taken or sufficient experience has been 
    gained, in accordance with Sec. 26.46.
        (c) Decisions concerning the equivalence of CAB's must be agreed to 
    by both parties.
    
    [[Page 17754]]
    
    Sec. 26.40  Start of the operational period.
    
        (a) The operational period will start at the end of the transition 
    period after the parties have developed the list of conformity 
    assessment bodies (CAB's) found to be equivalent. The provisions of 
    Secs. 26.40, 26.41, 26.42, 26.43, 26.44, 26.45, and 26.46 will apply 
    only with regard to listed CAB's and only to the extent of any 
    specifications and limitations contained on the list with regard to a 
    CAB.
        (b) The operational period will apply to quality system evaluation 
    reports and product evaluation reports generated by CAB's listed in 
    accordance with this subpart for the evaluations performed in the 
    respective territories of the parties, except if the parties agree 
    otherwise.
    
    
    Sec. 26.41  Exchange and endorsement of quality system evaluation 
    reports.
    
        (a) Listed European Community (EC) conformity assessment bodies 
    (CAB's) will provide FDA with reports of quality system evaluations, as 
    follows:
        (1) For preapproval quality system evaluations, EC CAB's will 
    provide full reports; and
        (2) For surveillance quality system evaluations, EC CAB's will 
    provide abbreviated reports.
        (b) Listed U.S. CAB's will provide to the EC Notified Body of the 
    manufacturer's choice:
        (1) Full reports of initial quality system evaluations;
        (2) Abbreviated reports of quality systems surveillance audits.
        (c) If the abbreviated reports do not provide sufficient 
    information, the importing party may request additional clarification 
    from the CAB.
        (d) Based on the determination of equivalence in light of the 
    experience gained, the quality system evaluation reports prepared by 
    the CAB's listed as equivalent will normally be endorsed by the 
    importing party, except under specific and delineated circumstances. 
    Examples of such circumstances include indications of material 
    inconsistencies or inadequacies in a report, quality defects identified 
    in postmarket surveillance or other specific evidence of serious 
    concern in relation to product quality or consumer safety. In such 
    cases, the importing party may request clarification from the exporting 
    party which may lead to a request for reinspection. The parties will 
    endeavor to respond to requests for clarification in a timely manner. 
    Where divergence is not clarified in this process, the importing party 
    may carry out the quality system evaluation.
    
    
    Sec. 26.42  Exchange and endorsement of product evaluation reports.
    
        (a) European Community (EC) conformity assessment bodies (CAB's) 
    listed for this purpose will, subject to the specifications and 
    limitations on the list, provide to FDA 510(k) premarket notification 
    assessment reports prepared to U.S. medical device requirements.
        (b) U.S. CAB's will, subject to the specifications and limitations 
    on the list, provide to the EC Notified Body of the manufacturer's 
    choice, type examination, and verification reports prepared to EC 
    medical device requirements.
        (c) Based on the determination of equivalence in light of the 
    experience gained, the product evaluation reports prepared by the CAB's 
    listed as equivalent will normally be endorsed by the importing party, 
    except under specific and delineated circumstances. Examples of such 
    circumstances include indications of material inconsistencies, 
    inadequacies, or incompleteness in a product evaluation report, or 
    other specific evidence of serious concern in relation to product 
    safety, performance, or quality. In such cases, the importing party may 
    request clarification from the exporting party which may lead to a 
    request for a reevaluation. The parties will endeavor to respond to 
    requests for clarification in a timely manner. Endorsement remains the 
    responsibility of the importing party.
    
    
    Sec. 26.43  Transmission of quality system evaluation reports.
    
        Quality system evaluation reports covered by Sec. 26.41 concerning 
    products covered by this subpart shall be transmitted to the importing 
    party within 60 calendar days of a request by the importing party. 
    Should a new inspection be requested, the time period shall be extended 
    by an additional 30 calendar days. A party may request a new 
    inspection, for cause, identified to the other party. If the exporting 
    party cannot perform an inspection within a specified period of time, 
    the importing party may perform an inspection on its own.
    
    
    Sec. 26.44  Transmission of product evaluation reports.
    
        Transmission of product evaluation reports will take place 
    according to the importing party's specified procedures.
    
    
    Sec. 26.45  Monitoring continued equivalence.
    
        Monitoring activities will be carried out in accordance with 
    Sec. 26.69.
    
    
    Sec. 26.46  Listing of additional CAB's.
    
        (a) During the operational phase, additional conformity assessment 
    bodies (CAB's) will be considered for equivalence using the procedures 
    and criteria described in Secs. 26.36, 26.37, and 26.39, taking into 
    account the level of confidence gained in the overall regulatory system 
    of the other party.
        (b) Once a designating authority considers that such CAB's, having 
    undergone the procedures of Secs. 26.36, 26.37, and 26.39, may be 
    determined to be equivalent, it will then designate those bodies on an 
    annual basis. Such procedures satisfy the procedures of Sec. 26.66(a) 
    and (b).
        (c) Following such annual designations, the procedures for 
    confirmation of CAB's under Sec. 26.66(c) and (d) shall apply.
    
    
    Sec. 26.47  Role and composition of the Joint Sectoral Committee.
    
        (a) The Joint Sectoral Committee for this subpart is set up to 
    monitor the activities under both the transitional and operational 
    phases of this subpart.
        (b) The Joint Sectoral Committee will be cochaired by a 
    representative of the Food and Drug Administration (FDA) for the United 
    States and a representative of the European Community (EC) who will 
    each have one vote. Decisions will be taken by unanimous consent.
        (c) The Joint Sectoral Committee's functions will include:
        (1) Making a joint assessment of the equivalence of conformity 
    assessment bodies (CAB's);
        (2) Developing and maintaining the list of equivalent CAB's, 
    including any limitation in terms of their scope of activities and 
    communicating the list to all authorities and the Joint Committee 
    described in subpart C of this part;
        (3) Providing a forum to discuss issues relating to this subpart, 
    including concerns that a CAB may no longer be equivalent and 
    opportunity to review product coverage; and
        (4) Consideration of the issue of suspension.
    
    
    Sec. 26.48   Harmonization.
    
        During both the transitional and operational phases of this 
    subpart, both parties intend to continue to participate in the 
    activities of the Global Harmonization Task Force and utilize the 
    results of those activities to the extent possible. Such participation 
    involves developing and reviewing documents developed by the Global 
    Harmonization Task Force and jointly determining whether they are 
    applicable to the implementation of this subpart.
    
    
    Sec. 26.49  Regulatory cooperation.
    
        (a) The parties and authorities shall inform and consult with one 
    another, as permitted by law, of proposals to
    
    [[Page 17755]]
    
    introduce new controls or to change existing technical regulations or 
    inspection procedures and to provide the opportunity to comment on such 
    proposals.
        (b) The parties shall notify each other in writing of any changes 
    to Appendix A of this subpart.
    
    
    Sec. 26.50  Alert system and exchange of postmarket vigilance reports.
    
        (a) An alert system will be set up during the transition period and 
    maintained thereafter by which the parties will notify each other when 
    there is an immediate danger to public health. Elements of such a 
    system will be described in an Appendix F of this subpart. As part of 
    that system, each party shall notify the other party of any confirmed 
    problem reports, corrective actions, or recalls. These reports are 
    regarded as part of ongoing investigations.
        (b) Contact points will be agreed between both parties to permit 
    authorities to be made aware with the appropriate speed in case of 
    quality defect, batch recalls, counterfeiting and other problems 
    concerning quality, which could necessitate additional controls or 
    suspension of the distribution of the product.
    
    Appendix A of Subpart B--Relevant Legislation, Regulations and 
    Procedures
    
    1. For the European Community (EC) the following legislation applies to 
    Sec. 26.42(a) of this subpart:
    
        [Copies of EC documents may be obtained from the European 
    Document Research, 1100 17th St. NW., suite 301, Washington, DC 
    20036.]
    a. Council Directive 90/385/EEC of 20 June 1990 on active 
    implantable medical devices
        OJ No. L 189, 20.7. 1990, p. 17. Conformity assessment 
    procedures.
        Annex 2 (with the exception of section 4)
        Annex 4
        Annex 5
    b. Council Directive 93/42/EEC of 14 June 1993 on Medical Devices OJ 
    No. L 169,12.7.1993, p.1. Conformity assessment procedures.
        Annex 2 (with the exception of section 4)
        Annex 3
        Annex 4
        Annex 5
        Annex 6
    
    2. For the United States, the following legislation applies to 
    Sec. 26.32(a):
    
        [Copies of FDA documents may be obtained from the Government 
    Printing Office, 1510 H St. NW., Washington, DC 20005. FDA documents 
    may be viewed on FDA's Internet web site at ``http://www.fda.gov''.]
    a. The Federal Food, Drug and Cosmetic Act, 21 U.S.C. 321 et seq.
    b. The Public Health Service Act, 42 U.S.C. 201 et seq.
    c. Regulations of the United States Food and Drug Administration 
    found at 21 CFR, in particular, Parts 800 to 1299.
    d. Medical Devices; Third Party Review of Selected Premarket 
    Notifications; Pilot Program, 61 FR 14789-14796 (April 3, 1996).
    
    Appendix B of Subpart B--Scope of Product Coverage
    
    1. Initial Coverage of the Transition Period
    
    Upon entry into force of this subpart as described in Sec. 26.80 (it 
    is understood that the date of entry into force will not occur prior 
    to June 1, 1998, unless the parties decide otherwise), products 
    qualifying for the transitional arrangements under this subpart 
    include:
        a. All Class I products requiring premarket evaluations in the 
    United States--see Table 1.
        b. Those Class II products listed in Table 2.
    
    2. During the Transition Period
    
    The parties will jointly identify additional product groups, 
    including their related accessories, in line with their respective 
    priorities as follows:
        a. Those for which review may be based primarily on written 
    guidance which the parties will use their best efforts to prepare 
    expeditiously; and
        b. Those for which review may be based primarily on 
    international standards, in order for the parties to gain the 
    requisite experience.
    The corresponding additional product lists will be phased in on an 
    annual basis. The parties may consult with industry and other 
    interested parties in determining which products will be added.
    
    3. Commencement of the Operational Period
    
        a. At the commencement of the operational period, product 
    coverage shall extend to all Class I/II products covered during the 
    transition period.
        b. FDA will expand the program to categories of Class II devices 
    as is consistent with the results of the pilot, and with FDA's 
    ability to write guidance documents if the device pilot for the 
    third party review of medical devices is successful. The MRA will 
    cover to the maximum extent feasible all Class II devices listed in 
    Table 3 for which FDA-accredited third party review is available in 
    the United States.
    
    4. Unless explicitly included by joint decision of the parties, this 
    part does not cover any U.S. Class II-tier 3 or any Class III product 
    under either system.
    
        [FDA is codifying the lists of medical devices contained in the 
    following tables as they appear in the medical device annex of the 
    ``Agreement on Mutual Recognition Between the United States of 
    America and the European Community.'' As a result of the Food and 
    Drug Administration Modernization Act of 1997, however, the medical 
    devices included in these tables will change.]
    
    Table 1.--Class I Products Requiring Premarket Evaluations in the United
    States, Included in Scope of Product Coverage at Beginning of Transition
                                    Period\1\                               
    ------------------------------------------------------------------------
              21 CFR Section No.                    Regulation Name         
    ------------------------------------------------------------------------
                                               Product Code--Device Name    
    ------------------------------------------------------------------------
    Anesthesiology Panel (21 CFR Part                                       
     868)                                                                   
        868.1910                           Esophageal Stethoscope           
                                           BZW--Stethoscope, Esophageal     
        868.5620                           Breathing Mouthpiece             
                                           BYP--Mouthpiece, Breathing       
        868.5640                           Medicinal Nonventilatory         
                                            Nebulizer (Atomizer)            
                                           CCQ--Nebulizer, Medicinal,       
                                            Nonventilatory (Atomizer)       
        868.5675                           Rebreathing Device               
                                           BYW--Device, Rebreathing         
        868.5700                           Nonpowered Oxygen Tent           
                                           FOG--Hood, Oxygen, Infant        
                                           BYL--Tent, Oxygen                
        868.6810                           Tracheobronchial Suction Catheter
                                           BSY--Catheters, Suction,         
                                            Tracheobronchial                
    
    [[Page 17756]]
    
                                                                            
    Cardiovascular Panel                                                    
        (None)                                                              
    Dental Panel (21 CFR Part 872)                                          
        872.3400                           Karaya and Sodium Borate With or 
                                            Without Acacia Denture Adhesive 
                                           KOM--Adhesive, Denture, Acacia   
                                            and Karaya With Sodium Borate   
        872.3700                           Dental Mercury (U.S.P.)          
                                           ELY--Mercury                     
        872.4200                           Dental Handpiece and Accessories 
                                           EBW--Controller, Food, Handpiece 
                                            and Cord                        
                                           EFB--Handpiece, Air-Powered,     
                                            Dental                          
                                           EFA--Handpiece, Belt and/or Gear 
                                            Driven, Dental                  
                                           EGS--Handpiece, Contra- and Right-
                                            Angle Attachment, Dental        
                                           EKX--Handpiece, Direct Drive, AC-
                                            Powered                         
                                           EKY--Handpiece, Water-Powered    
        872.6640                           Dental Operative Unit and        
                                            Accessories                     
                                           EIA--Unit, Operative Dental      
    Ear, Nose, and Throat Panel (21 CFR                                     
     Part 874)                                                              
        874.1070                           Short Increment Sensitivity Index
                                            (SISI) Adapter                  
                                           ETR--Adapter, Short Increment    
                                            Sensitivity Index (SISI)        
        874.1500                           Gustometer                       
                                           ETM--Gustometer                  
        874.1800                           Air or Water Caloric Stimulator  
                                           KHH--Stimulator, Caloric-Air     
                                           ETP--Stimulator, Caloric-Water   
        874.1925                           Toynbee Diagnostic Tube          
                                           ETK--Tube, Toynbee Diagnostic    
        874.3300                           Hearing Aid                      
                                           LRB--Face Plate Hearing-Aid      
                                           ESD--Hearing-aid, Air-Conduction 
        874.4100                           Epistaxis Balloon                
                                           EMX--Balloon, Epistaxis          
        874.5300                           ENT Examination and Treatment    
                                            Unit                            
                                           ETF--Unit, Examining/Treatment,  
                                            ENT                             
        874.5550                           Powered Nasal Irrigator          
                                           KMA--Irrigator, Powered Nasal    
        874.5840                           Antistammering Device            
                                           KTH--Device, Anti-Stammering     
    Gastroenterology--Urology Panel (21                                     
     CFR Part 876)                                                          
        876.5160                           Urological Clamp for Males       
                                           FHA--Clamp, Penile               
        876.5210                           Enema Kit                        
                                           FCE--Kit, Enema, (for Cleaning   
                                            Purpose)                        
        876.5250                           Urine Collector and Accessories  
                                           FAQ--Bag, Urine Collection, Leg, 
                                            for External Use                
    General Hospital Panel (21 CFR Part                                     
     880)                                                                   
        880.5270                           Neonatal Eye Pad                 
                                           FOK--Pad, Neonatal Eye           
        880.5420                           Pressure Infusor for an I.V. Bag 
                                           KZD--Infusor, Pressure, for I.V. 
                                            Bags                            
        880.5680                           Pediatric Position Holder        
                                           FRP--Holder, Infant Position     
        880.6250                           Patient Examination Glove        
                                           LZB--Finger Cot                  
                                           FMC--Glove, Patient Examination  
                                           LYY--Glove, Patient Examination, 
                                            Latex                           
                                           LZA--Glove, Patient Examination, 
                                            Poly                            
                                           LZC--Glove, Patient Examination, 
                                            Speciality                      
                                           LYZ--Glove, Patient Examination, 
                                            Vinyl                           
        880.6375                           Patient Lubricant                
                                           KMJ--Lubricant, Patient          
        880.6760                           Protective Restraint             
                                           BRT--Restraint, Patient,         
                                            Conductive                      
                                           FMQ--Restraint, Protective       
    Neurology Panel (21 CFR Part 882)                                       
        882.1030                           Ataxiagraph                      
                                           GWW--Ataxiagraph                 
        882.1420                           Electroencephalogram (EEG) Signal
                                            Spectrum Analyzer               
                                           GWS--Analyzer, Spectrum,         
                                            Electroencephalogram Signal     
    
    [[Page 17757]]
    
                                                                            
        882.4060                           Ventricular Cannula              
                                           HCD--Cannula, Ventricular        
        882.4545                           Shunt System Implantation        
                                            Instrument                      
                                           GYK--Instrument, Shunt System    
                                            Implantation                    
        882.4650                           Neurosurgical Suture Needle      
                                           HAS--Needle, Neurosurgical Suture
        882.4750                           Skull Punch                      
                                           GXJ--Punch, Skull                
    Obstetrics and Gynecology Panel                                         
        (None)                                                              
    Ophthalmology Panel (21 CFR Part 886)                                   
        886.1780                           Retinoscope                      
                                           HKM--Retinoscope, Battery-Powered
        886.1940                           Tonometer Sterilizer             
                                           HKZ--Sterilizer, Tonometer       
        886.4070                           Powered Corneal Burr             
                                           HQS--Burr, Corneal, AC-Powered   
                                           HOG--Burr, Corneal, Battery-     
                                            Powered                         
                                           HRG--Engine, Trephine,           
                                            Accessories, AC-Powered         
                                           HFR--Engine, Trephine,           
                                            Accessories, Battery-Powered    
                                           HLD--Engine, Trephine,           
                                            Accessories, Gas-Powered        
        886.4370                           Keratome                         
                                           HNO--Keratome, AC-Powered        
                                           HMY--Keratome, Battery-Powered   
        886.5850                           Sunglasses (Nonprescription)     
                                           HQY--Sunglasses (Nonprescription 
                                            Including Photosensitive)       
    Orthopedic Panel (21 CFR Part 888)                                      
        888.1500                           Goniometer                       
                                           KQX--Goniometer, AC-Powered      
        888.4150                           Calipers for Clinical Use        
                                           KTZ--Caliper                     
    Physical Medicine Panel (21 CFR Part                                    
     890)                                                                   
        890.3850                           Mechanical Wheelchair            
                                           LBE--Stroller, Adaptive          
                                           IOR--Wheelchair, Mechanical      
        890.5180                           Manual Patient Rotation Bed      
                                           INY--Bed, Patient Rotation,      
                                            Manual                          
        890.5710                           Hot or Cold Disposable Pack      
                                           IMD--Pack, Hot or Cold,          
                                            Disposable                      
    Radiology Panel (21 CFR Part 892)                                       
        892.1100                           Scintillation (Gamma) Camera     
                                           IYX--Camera, Scintillation       
                                            (Gamma)                         
        892.1110                           Positron Camera                  
                                           IZC--Camera, Positron            
        892.1300                           Nuclear Rectilinear Scanner      
                                           IYW--Scanner, Rectilinear,       
                                            Nuclear                         
        892.1320                           Nuclear Uptake Probe             
                                           IZD--Probe, Uptake, Nuclear      
        892.1330                           Nuclear Whole Body Scanner       
                                           JAM--Scanner, Whole Body, Nuclear
        892.1410                           Nuclear Electrocardiograph       
                                            Synchronizer                    
                                           IVY--Synchronizer,               
                                            Electrocardiograph, Nuclear     
        892.1890                           Radiographic Film Illuminator    
                                           IXC--Illuminator, Radiographic-  
                                            Film                            
                                            JAG--Illuminator, Radiographic- 
                                            Film, Explosion-Proof           
        892.1910                           Radiographic Grid                
                                           IXJ--Grid, Radiographic          
        892.1960                           Radiographic Intensifying Screen 
                                           WAM--Screen, Intensifying,       
                                            Radiographic                    
        892.1970                           Radiographic ECG/Respirator      
                                            Synchronizer                    
                                           IXO--Synchronizer, ECG/          
                                            Respirator, Radiographic        
        892.5650                           Manual Radionuclide Applicator   
                                            System                          
                                           IWG--System, Applicator,         
                                            Radionuclide, Manual            
    General and Plastic Surgery Panel (21                                   
     CFR Part 878)                                                          
         878.4200                          Introduction/Drainage Catheter   
                                            and Accessories                 
                                           KGZ--Accessories, Catheter       
                                           GCE--Adaptor, Catheter           
                                           FGY--Cannula, Injection          
                                           GBA--Catheter, Balloon Type      
    
    [[Page 17758]]
    
                                                                            
                                           GBZ--Catheter, Cholangiography   
                                           GBQ--Catheter, Continuous        
                                            Irrigation                      
                                           GBY--Catheter, Eustachian,       
                                            General & Plastic Surgery       
                                           JCY--Catheter, Infusion          
                                           GBX--Catheter, Irrigation        
                                           GBP--Catheter, Multiple Lumen    
                                           GBO--Catheter, Nephrostomy,      
                                            General & Plastic Surgery       
                                           GBN--Catheter, Pediatric, General
                                            & Plastic Surgery               
                                           GBW--Catheter, Peritoneal        
                                           GBS--Catheter, Ventricular,      
                                            General & Plastic Surgery       
                                           GCD--Connector, Catheter         
                                           GCC--Dilator, Catheter           
                                           GCB--Needle, Catheter            
        878.4320                           Removable Skin Clip              
                                           FZQ--Clip, Removable (Skin)      
        878.4460                           Surgeon's Gloves                 
                                           KGO--Surgeon's Gloves            
        878.4680                           Nonpowered, Single Patient,      
                                            Portable Suction Apparatus      
                                           GCY--Apparatus, Suction, Single  
                                            Patient Use, Portable,          
                                            Nonpowered                      
        878.4760                           Removable Skin Staple            
                                           GDT--Staple, Removable (Skin)    
        878.4820                           AC-Powered, Battery-Powered, and 
                                            Pneumatically Powered Surgical  
                                            Instrument Motors and           
                                            Accessories/Attachments         
                                           GFG--Bit, Surgical               
                                           GFA--Blade, Saw, General &       
                                            Plastic Surgery                 
                                           DWH--Blade, Saw, Surgical,       
                                            Cardiovascular                  
                                           BRZ--Board, Arm (With Cover)     
                                           GFE--Brush, Dermabrasion         
                                           GFF--Bur, Surgical, General &    
                                            Plastic Surgery                 
                                           KDG--Chisel (Osteotome)          
                                           GFD--Dermatome                   
                                           GFC--Driver, Surgical, Pin       
                                           GFB--Head, Surgical, Hammer      
                                           GEY--Motor, Surgical Instrument, 
                                            AC-Powered                      
                                           GET--Motor, Surgical Instrument, 
                                            Pneumatic Powered               
                                           DWI--Saw, Electrically Powered   
                                           KFK--Saw, Pneumatically Powered  
                                           HAB--Saw, Powered, and           
                                            Accessories                     
        878.4960                           Air or AC-Powered Operating Table
                                            and Air or AC-Powered Operating 
                                            Chair & Accessories             
                                           GBB--Chair, Surgical, AC-Powered 
                                           FQO--Table, Operating-Room, AC-  
                                            Powered                         
                                           GDC--Table, Operating-Room,      
                                            Electrical                      
                                            FWW--Table, Operating-Room,     
                                            Pneumatic                       
                                           JEA--Table, Surgical with        
                                            Orthopedic Accessories, AC-     
                                            Powered                         
        880.5090                           Liquid Bandage                   
                                           KMF--Bandage, Liquid             
    ------------------------------------------------------------------------
    \1\Descriptive information on product codes, panel codes, and other     
      medical device identifiers may be viewed on FDA's Internet Web Site at
      ``http://www.fda.gov/cdrh/prodcode.html''.                            
    
    
    Table 2.--Class II Medical Devices Included in Scope of Product Coverage
      at Beginning of Transition Period (United States to develop guidance  
     documents identifying U.S. requirements and European Community (EC) to 
              identify standards needed to meet EC requirements)\1\         
    ------------------------------------------------------------------------
         Panel        21 CFR Section              Regulation Name           
    ----------------        No.       --------------------------------------
                    ------------------                                      
                                             Product Code--Device Name      
    ------------------------------------------------------------------------
        RA           892.1000          Magnetic Resonance Diagnostic Device 
                                       MOS--COIL, Magnetic Resonance,       
                                        Specialty                           
                                       LNH--System, Nuclear Magnetic        
                                        Resonance Imaging                   
                                       LNI--System, Nuclear Magnetic        
                                        Resonance Spectroscopic             
    Diagnostic                                                              
     Ultrasound:                                                            
        RA           892.1540          Nonfetal Ultrasonic Monitor          
                                       JAF--Monitor, Ultrasonic, Nonfetal   
        RA           892.1550          Ultrasonic Pulsed Doppler Imaging    
                                        System                              
                                       IYN--System, Imaging, Pulsed Doppler,
                                        Ultrasonic                          
    
    [[Page 17759]]
    
                                                                            
        RA           892.1560          Ultrasonic Pulsed Echo Imaging System
                     ................  IYO--System, Imaging, Pulsed Echo,   
                                        Ultrasonic                          
        RA           892.1570          Diagnostic Ultrasonic Transducer     
                     ................  ITX--Transducer, Ultrasonic,         
                                        Diagnostic                          
    Diagnostic X-                                                           
     Ray Imaging                                                            
     Devices                                                                
     (except                                                                
     mammographic x-                                                        
     ray systems):                                                          
        RA           892.1600          Angiographic X-Ray System            
                                       IZI--System, X-Ray, Angiographic     
        RA           892.1650          Image-Intensified Fluoroscopic X-Ray 
                                        System                              
                                       MQB--Solid State X-Ray Imager (Flat  
                                        Panel/Digital Imager)               
                                       JAA--System, X-Ray, Fluoroscopic,    
                                        Image-Intensified                   
        RA           892.1680          Stationary X-Ray System              
                                       KPR--System, X-Ray, Stationary       
        RA           892.1720          Mobile X-Ray System                  
                                       IZL--System, X-Ray, Mobile           
        RA           892.1740          Tomographic X-Ray System             
                                       IZF--System, X-Ray, Tomographic      
        RA           892.1750          Computed Tomography X-Ray System     
                                       JAK--System, X-Ray, Tomography,      
                                        Computed                            
    ECG-Related                                                             
     Devices:                                                               
        CV           870.2340          Electrocardiograph                   
                     ................  DPS--Electrocardiograph              
                     ................  MLC--Monitor, ST Segment             
        CV           870.2350          Electrocardiograph Lead Switching    
                                        Adaptor                             
                                       DRW--Adaptor, Lead Switching,        
                                        Electrocardiograph                  
        CV           870.2360          Electrocardiograph Electrode         
                                       DRX--Electrode, Electrocardiograph   
        CV           870.2370          Electrocardiograph Surface Electrode 
                                        Tester                              
                                       KRC--Tester, Electrode, Surface,     
                                        Electrocardiographic                
        NE           882.1400          Electroencephalograph                
                                       GWQ--Electroencephalograph           
        HO           880.5725          Infusion Pump (external only)        
                                       MRZ--Accessories, Pump, Infusion     
                                       FRN--Pump, Infusion                  
                                       LZF--Pump, Infusion, Analytical      
                                        Sampling                            
                                       MEB--Pump, Infusion, Elastomeric     
                                       LZH--Pump, Infusion, Enteral         
                                       MHD--Pump, Infusion, Gallstone       
                                        Dissolution                         
                                       LZG--Pump, Infusion, Insulin         
                                       MEA--Pump, Infusion, PCA             
    Ophthalmic                                                              
     Instruments:                                                           
        OP            886.1570         Ophthalmoscope                       
                                       HLI--Ophthalmoscope, AC-Powered      
                                       HLJ--Ophthalmoscope, Battery-Powered 
        OP           886.1780          Retinoscope                          
                                       HKL--Retinoscope, AC-Powered         
        OP           886.1850          AC-Powered Slit-Lamp Biomicroscope   
                                       HJO--Biomicroscope, Slit-Lamp, AC-   
                                        Powered                             
        OP           886.4150          Vitreous Aspiration and Cutting      
                                        Instrument                          
                                       MMC--Dilator, Expansive Iris         
                                        (Accessory)                         
                                       HQE--Instrument, Vitreous Aspiration 
                                        and Cutting, AC-Powered             
                                       HKP--Instrument, Vitreous Aspiration 
                                        and Cutting, Battery-Powered        
                                       MLZ--Vitrectomy, Instrument Cutter   
        OP           886.4670          Phacofragmentation System            
                                       HQC--Unit, Phacofragmentation        
        SU           878.4580          Surgical Lamp                        
                                       HBI--Illuminator, Fiberoptic,        
                                        Surgical Field                      
                                       FTF--Illuminator, Nonremote          
                                       FTG--Illuminator, Remote             
                                       HJE--Lamp, Fluorescein, AC-Powered   
                                       FQP--Lamp, Operating-Room            
                                       FTD--Lamp, Surgical                  
                                       GBC--Lamp, Surgical, Incandescent    
                                       FTA--Light, Surgical, Accessories    
                                       FSZ--Light, Surgical, Carrier        
                                       FSY--Light, Surgical, Ceiling Mounted
    
    [[Page 17760]]
    
                                                                            
                                       FSX--Light, Surgical, Connector      
                                       FSW--Light, Surgical, Endoscopic     
                                       FST--Light, Surgical, Fiberoptic     
                                       FSS--Light, Surgical, Floor Standing 
                                       FSQ--Light, Surgical, Instrument     
        NE           882.5890          Transcutaneous Electrical Nerve      
                                        Stimulator for Pain Relief          
                                       GZJ--Stimulator, Nerve,              
                                        Transcutaneous, For Pain Relief     
                                       Noninvasive Blood Pressure           
                                        Measurement Devices:                
        CV           870.1120          Blood Pressure Cuff                  
                                       DXQ--Cuff, Blood-Pressure            
        CV           870.1130          Noninvasive Blood Pressure           
                                        Measurement System (except          
                                        nonoscillometric)                   
                                       DXN--System, Measurement, Blood-     
                                        Pressure, Noninvasive               
        HO           880.6880          Steam Sterilizer (greater than 2     
                                        cubic feet)                         
                                       FLE--Sterilizer, Steam               
    Clinical                                                                
     Thermometers:                                                          
        HO           880.2910          Clinical Electronic Thermometer      
                                        (except tympanic or pacifier)       
                                       FLL--Thermometer, Electronic,        
                                        Clinical                            
        AN           868.5630          Nebulizer                            
                                       CAF--Nebulizer (Direct Patient       
                                        Interface)                          
        AN           868.5925          Powered Emergency Ventilator         
    Hypodermic                                                              
     Needles and                                                            
     Syringes                                                               
     (except                                                                
     antistick and                                                          
     self-                                                                  
     destruct):                                                             
        HO           880.5570          Hypodermic Single Lumen Needle       
                                       MMK--Container, Sharpes              
                                       FMI--Needle, Hypodermic, Single Lumen
                                       MHC--Port, Intraosseous, Implanted   
        HO           880.5860          Piston Syringe                       
                                       FMF--Syringe, Piston                 
        OR           888.3020          Intramedullary Fixation Rod          
                                       HSB--ROD, Fixation, Intramedullary   
                                        and Accessories                     
    External                                                                
     Fixators                                                               
     (except                                                                
     devices with                                                           
     no external                                                            
     components):                                                           
        OR           888.3030          Single/Multiple Component Metallic   
                                        Bone Fixation Appliances and        
                                        Accessories                         
                                       KTT--Appliance, Fixation, Nail/Blade/
                                        Plate Combination, Multiple         
                                        Component                           
        OR           888.3040          Smooth or Threaded Metallic Bone     
                                        Fixation Fastener                   
                                       JEC--Component, Traction, Invasive   
                                       HTY--Pin, Fixation, Smooth           
                                       JDW--Pin, Fixation, Threaded         
    Selected Dental                                                         
     Materials:                                                             
        DE           872.3060          Gold-Based Alloys and Precious Metal 
                                        Alloys for Clinical Use             
                                       EJT--Alloy, Gold Based, For Clinical 
                                        Use                                 
                                       EJS--Alloy, Precious Metal, For      
                                        Clinical Use                        
        DE           872.3200          Resin Tooth Bonding Agent            
                                        KLE--Agent, Tooth Bonding, Resin    
        DE           872.3275          Dental Cement                        
                                       EMA--Cement, Dental                  
                                       EMB--Zinc Oxide Eugenol              
        DE           872.3660          Impression Material                  
                                       ELW--Material, Impression            
        DE           872.3690          Tooth Shade Resin Material           
                                       EBF--Material, Tooth Shade, Resin    
        DE            872.3710         Base Metal Alloy                     
                                       EJH--Metal, Base                     
    Latex Condoms:                                                          
        OB           884.5300          Condom                               
                                       HIS--Condom                          
    ------------------------------------------------------------------------
    \1\Descriptive information on product codes, panel codes, and other     
      medical device identifiers may be viewed on FDA's Internet Web Site at
      ``http://www.fda.gov/cdrh/prodcode.html''.                            
    
    
    [[Page 17761]]
    
    
      Table 3.--Medical Devices for Possible Inclusion in Scope of Product  
                      Coverage During Operational Period\1\                 
    ------------------------------------------------------------------------
      Product Family   21 CFR Section No     Device Name          Tier      
    ------------------------------------------------------------------------
    Anesthesiology                                                          
     Panel                                                                  
        Anesthesia     868.5160           Gas machine for   2               
         Devices                           anesthesia or                    
                                           analgesia                        
                       868.5270           Breathing system  2               
                                           heater                           
                       868.5440           Portable oxygen   2               
                                           generator                        
                       868.5450           Respiratory gas   2               
                                           humidifier                       
                       868.5630           Nebulizer         2               
                       868.5710           Electrically       2              
                                           powered oxygen                   
                                           tent                             
                       868.5880           Anesthetic        2               
                                           vaporizer                        
        Gas Analyser   868.1040           Powered           2               
                                           Algesimeter                      
                       868.1075           Argon gas         2               
                                           analyzer                         
                       868.1400           Carbon dioxide    2               
                                           gas analyzer                     
                       868.1430           Carbon monoxide   2               
                                           gas analyzer                     
                       868.1500           Enflurane gas     2               
                                           analyzer                         
                       868.1620           Halothane gas     2               
                                           analyzer                         
                       868.1640           Helium gas        2               
                                           analyzer                         
                       868.1670           Neon gas          2               
                                           analyzer                         
                       868.1690           Nitrogen gas      2               
                                           analyzer                         
                       868.1700           Nitrous oxide     2               
                                           gas analyzer                     
                       868.1720           Oxygen gas        2               
                                           analyzer                         
                       868.1730           Oxygen uptake     2               
                                           computer                         
        Peripheral     868.2775           Electrical        2               
         Nerve                             peripheral                       
         Stimulators                       nerve                            
                                           stimulator                       
        Respiratory    868.1750           Pressure          2               
         Monitoring                        plethysmograph                   
                       868.1760           Volume            2               
                                           plethysmograph                   
                       868.1780           Inspiratory       2               
                                           airway pressure                  
                                           meter                            
                       868.1800           Rhinoanemometer   2               
                       868.1840           Diagnostic        2               
                                           spirometer                       
                       868.1850           Monitoring        2               
                                           spirometer                       
                       868.1860           Peak-flow meter   2               
                                           for spirometry                   
                       868.1880           Pulmonary-        2               
                                           function data                    
                                           calculator                       
                       868.1890           Predictive        2               
                                           pulmonary-                       
                                           function value                   
                                           calculator                       
                       868.1900           Diagnostic        2               
                                           pulmonary-                       
                                           function                         
                                           interpretation                   
                                           calculator                       
                       868.2025           Ultrasonic air    2               
                                           embolism                         
                                           monitor                          
                       868.2375           Breathing         2               
                                           frequency                        
                                           monitor (except                  
                                           apnea                            
                                           detectors)                       
                       868.2480           Cutaneous carbon  2               
                                           dioxide (PcCO2)                  
                                           monitor                          
                       868.2500           Cutaneous oxygen  2               
                                           monitor (for an                  
                                           infant not                       
                                           under gas                        
                                           anesthesia)                      
                       868.2550           Pneumotachomomet  2               
                                           er                               
                       868.2600           Airway pressure   2               
                                           monitor                          
                       868.5665           Powered           2               
                                           percussor                        
                       868.5690           Incentive         2               
                                           spirometer                       
        Ventilator     868.5905           Noncontinuous     2               
                                           ventilator                       
                                           (IPPB)                           
                       868.5925           Powered           2               
                                           emergency                        
                                           ventilator                       
                       868.5935           External          2               
                                           negative                         
                                           pressure                         
                                           ventilator                       
                       868.5895           Continuous        2               
                                           ventilator                       
                       868.5955           Intermittent      2               
                                           mandatory                        
                                           ventilation                      
                                           attachment                       
                       868.6250           Portable air      2               
                                           compressor                       
    Cardiovascular                                                          
     Panel                                                                  
        Cardiovascula  870.1425           Programmable      2               
         r Diagnostic                      diagnostic                       
                                           computer                         
                       870.1450           Densitometer      2               
                       870.2310           Apex cardiograph  2               
                                           (vibrocardiogra                  
                                           ph)                              
                       870.2320           Ballistocardiogr  2               
                                           aph                              
                       870.2340           Electrocardiogra  2               
                                           ph                               
                       870.2350           Electrocardiogra  1               
                                           ph lead                          
                                           switching                        
                                           adaptor                          
                       870.2360           Electrocardiogra  2               
                                           ph electrode                     
                       870.2370           Electrocardiogra  2               
                                           ph surface                       
                                           electrode                        
                                           tester                           
                       870.2400           Vectorcardiograp  1               
                                           h                                
                       870.2450           Medical cathode-  1               
                                           ray tube                         
                                           display                          
    
    [[Page 17762]]
    
                                                                            
                       870.2675           Oscillometer      2               
                       870.2840           Apex              2               
                                           cardiographic                    
                                           transducer                       
                       870.2860           Heart sound       2               
                                           transducer                       
        Cardiovascula                     Valve, pressure                   
         r Monitoring                      relief,                          
                                           cardiopulmonary                  
                                           bypass                           
                       870.1100           Blood pressure    2               
                                           alarm                            
                       870.1110           Blood pressure    2               
                                           computer                         
                       870.1120           Blood pressure    2               
                                           cuff                             
                       870.1130           Noninvasive       2               
                                           blood pressure                   
                                           measurement                      
                                           system                           
                       870.1140           Venous blood      2               
                                           pressure                         
                                           manometer                        
                       870.1220           Electrode         2               
                                           recording                        
                                           catheter or                      
                                           electrode                        
                                           recording probe                  
                       870.1270           Intracavitary     2               
                                           phonocatheter                    
                                           system                           
                       870.1875           Stethoscope       2               
                                           (electronic)                     
                       870.2050           Biopotential      2               
                                           amplifier and                    
                                           signal                           
                                           conditioner                      
                       870.2060           Transducer        2               
                                           signal                           
                                           amplifier and                    
                                           conditioner                      
                       870.2100           Cardiovascular    2               
                                           blood flow-                      
                                           meter                            
                       870.2120           Extravascular     2               
                                           blood flow                       
                                           probe                            
                       870.2300           Cardiac monitor   2               
                                           (including                       
                                           cardiotachomete                  
                                           r and rate                       
                                           alarm)                           
                       870.2700           Oximeter          2               
                       870.2710           Ear oximeter      2               
                       870.2750           Impedance         2               
                                           phlebograph                      
                       870.2770           Impedance         2               
                                           plethysmograph                   
                       870.2780           Hydraulic,        2               
                                           pneumatic, or                    
                                           photoelectric                    
                                           plethysmographs                  
                       870.2850           Extravascular     2               
                                           blood pressure                   
                                           transducer                       
                       870.2870           Catheter tip      2               
                                           pressure                         
                                           transducer                       
                       870.2880           Ultrasonic        2               
                                           transducer                       
                       870.2890           Vessel occlusion  2               
                                           transducer                       
                       870.2900           Patient           2               
                                           transducer and                   
                                           electrode cable                  
                                           (including                       
                                           connector)                       
                       870.2910           Radiofrequency    2               
                                           physiological                    
                                           signal                           
                                           transmitter and                  
                                           receiver                         
                       870.2920           Telephone         2               
                                           electrocardiogr                  
                                           aph transmitter                  
                                           and receiver                     
                       870.4205           Cardiopulmonary   2               
                                           bypass bubble                    
                                           detector                         
                       870.4220           Cardiopulmonary   2               
                                           bypass heart-                    
                                           lung machine                     
                                           console                          
                       870.4240           Cardiovascular    2               
                                           bypass heat                      
                                           exchanger                        
                       870.4250           Cardiopulmonary   2               
                                           bypass                           
                                           temperature                      
                                           controller                       
                       870.4300           Cardiopulmonary   2               
                                           bypass gas                       
                                           control unit                     
                       870.4310           Cardiopulmonary   2               
                                           bypass coronary                  
                                           pressure gauge                   
                       870.4330           Cardiopulmonary   2               
                                           bypass on-line                   
                                           blood gas                        
                                           monitor                          
                       870.4340           Cardiopulmonary   2               
                                           bypass level                     
                                           sensing monitor                  
                                           and/or control                   
                       870.4370           Roller-type       2               
                                           cardiopulmonary                  
                                           bypass blood                     
                                           pump                             
                       870.4380           Cardiopulmonary   2               
                                           bypass pump                      
                                           speed control                    
                       870.4410           Cardiopulmonary   2               
                                           bypass in-line                   
                                           blood gas                        
                                           sensor                           
        Cardiovascula  870.5050           Patient care      2               
         r                                 suction                          
         Therapeutic                       apparatus                        
                       870.5900           Thermal           2               
                                           regulation                       
                                           system                           
        Defibrillator  870.5300           DC-               2               
                                           defribrillator                   
                                           (including                       
                                           paddles)                         
                       870.5325           Defibrillator     2               
                                           tester                           
    
    [[Page 17763]]
    
                                                                            
        Echocardiogra  870.2330           Echocardiograph   2               
         ph                                                                 
        Pacemaker &    870.1750           External          2               
         Accessories                       programmable                     
                                           pacemaker pulse                  
                                           generator                        
                       870.3630           Pacemaker         2               
                                           generator                        
                                           function                         
                                           analyzer                         
                       870.3640           Indirect          2               
                                           pacemaker                        
                                           generator                        
                                           function                         
                                           analyzer                         
                       870.3720           Pacemaker         2               
                                           electrode                        
                                           function tester                  
        Miscellaneous  870.1800           Withdrawal-       2               
                                           infusion pump                    
                       870.2800           Medical magnetic  2               
                                           tape recorder                    
                       None               Batteries,                        
                                           rechargeable,                    
                                           class II                         
                                           devices                          
    Dental Panel                                                            
        Dental         872.1720           Pulp tester       2               
         Equipment                                                          
                       872.1740           Caries detection  2               
                                           device                           
                       872.4120           Bone cutting      2               
                                           instrument and                   
                                           accessories                      
                       872.4465           Gas-powered jet   2               
                                           injector                         
                       872.4475           Spring-powered    2               
                                           jet injector                     
                       872.4600           Intraoral         2               
                                           ligature and                     
                                           wire lock                        
                       872.4840           Rotary scaler     2               
                       872.4850           Ultrasonic        2               
                                           scaler                           
                       872.4920           Dental            2               
                                           electrosurgical                  
                                           unit and                         
                                           accessories                      
                       872.6070           Ultraviolet       2               
                                           activator for                    
                                           polymerization                   
                       872.6350           Ultraviolet       2               
                                           detector                         
        Dental         872.3050           Amalgam alloy     2               
         Material                                                           
                       872.3060           Gold-based        2               
                                           alloys and                       
                                           precious metal                   
                                           alloys for                       
                                           clinical use                     
                       872.3200           Resin tooth       2               
                                           bonding agent                    
                       872.3250           Calcium           2               
                                           hydroxide                        
                                           cavity liner                     
                       872.3260           Cavity varnish    2               
                       872.3275           Dental cement     2               
                                           (other than                      
                                           zinc oxide-                      
                                           eugenol)                         
                       872.3300           Hydrophilic       2               
                                           resin coating                    
                                           for dentures                     
                       872.3310           Coating material  2               
                                           for resin                        
                                           fillings                         
                       872.3590           Preformed         2               
                                           plastic denture                  
                                           tooth                            
                       872.3660           Impression        2               
                                           material                         
                       872.3690           Tooth shade       2               
                                           resin material                   
                       872.3710           Base metal alloy  2               
                       872.3750           Bracket adhesive  2               
                                           resin and tooth                  
                                           conditioner                      
                       872.3760           Denture           2               
                                           relining,                        
                                           repairing, or                    
                                           rebasing resin                   
                       872.3765           Pit and fissure   2               
                                           sealant and                      
                                           conditioner                      
                       872.3770           Temporary crown   2               
                                           and bridge                       
                                           resin                            
                       872.3820           Root canal        2               
                                           filling resin                    
                                           (other than                      
                                           chloroform use)                  
                       872.3920           Porcelain tooth   2               
        Dental X-ray   872.1800           Extraoral source  2               
                                           x-ray system                     
                       872.1810           Intraoral source  2               
                                           x-ray system                     
         Dental        872.4880           Intraosseous      2               
         Implants                          fixation screw                   
                                           or wire                          
                       872.3890           Endodontic        2               
                                           stabilizing                      
                                           splint                           
        Orthodontic    872.5470           Orthodontic       2               
                                           plastic bracket                  
    Ear/Nose/Throat                                                         
     Panel                                                                  
        Diagnostic     874.1050           Audiometer        2               
         Equipment                                                          
                       874.1090           Auditory          2               
                                           impedance                        
                                           tester                           
                       874.1120           Electronic noise  2               
                                           generator for                    
                                           audiometric                      
                                           testing                          
                       874.1325           Electroglottogra  2               
                                           ph                               
                       874.1820           Surgical nerve    2               
                                           stimulator/                      
                                           locator                          
        Hearing Aids   874.3300           Hearing aid (for  2               
                                           bone-                            
                                           conduction)                      
                       874.3310           Hearing aid       2               
                                           calibrator and                   
                                           analysis system                  
                       874.3320           Group hearing     2               
                                           aid or group                     
                                           auditory                         
                                           trainer                          
    
    [[Page 17764]]
    
                                                                            
                       874.3330           Master hearing    2               
                                           aid                              
        Surgical       874.4250           Ear, nose, and    1               
         Equipment                         throat electric                  
                                           or pneumatic                     
                                           surgical drill                   
                       874.4490           Argon laser for   2               
                                           otology,                         
                                           rhinology, and                   
                                           laryngology                      
                       874.4500           Ear, nose, and    2               
                                           throat                           
                                           microsurgical                    
                                           carbon dioxide                   
                                           laser                            
    Gastroenterology/                                                       
     Urology Panel                                                          
        Endoscope      876.1500           Endoscope and     2               
         (including                        accessories                      
         angioscopes,                                                       
         laparscopes,                                                       
         ophthalmic                                                         
         endoscopes)                                                        
                       876.4300           Endoscopic        2               
                                           electrosurgical                  
                                           unit and                         
                                           accessories                      
        Gastroenterol  876.1725           Gastrointestinal  1               
         ogy                               motility                         
                                           monitoring                       
                                           system                           
        Hemodialysis   876.5600           Sorbent           2               
                                           regenerated                      
                                           dialysate                        
                                           delivery system                  
                                           for                              
                                           hemodialysis                     
                       876.5630           Peritoneal        2               
                                           dialysis system                  
                                           and accessories                  
                       876.5665           Water             2               
                                           purification                     
                                           system for                       
                                           hemodialysis                     
                       876.5820            Hemodialysis     2               
                                           system and                       
                                           accessories                      
                       876.5830           Hemodialyzer      2               
                                           with disposable                  
                                           insert (kiil-                    
                                           type)                            
        Lithotriptor   876.4500           Mechanical        2               
                                           lithotriptor                     
        Urology        876.1620           Urodynamics       2               
         Equipment                         measurement                      
                                           system                           
                       876.5320           Nonimplanted      2               
                                           electrical                       
                                           continence                       
                                           device                           
                       876.5880           Isolated kidney   2               
                                           perfusion and                    
                                           transport                        
                                           system and                       
                                           accessories                      
    General Hospital                                                        
     Panel                                                                  
        Infusion       880.2420           Electronic        2               
         Pumps and                         monitor for                      
         Systems                           gravity flow                     
                                           infusion                         
                                           systems                          
                       880.2460           Electrically      2               
                                           powered spinal                   
                                           fluid pressure                   
                                           monitor                          
                       880.5430           Nonelectrically   2               
                                           powered fluid                    
                                           injector                         
                       880.5725           Infusion pump     2               
        Neonatal       880.5400           Neonatal          2               
         Incubators                        incubator                        
                       880.5410           Neonatal          2               
                                           transport                        
                                           incubator                        
                       880.5700           Neonatal          2               
                                           phototherapy                     
                                           unit                             
        Piston         880.5570           Hypodermic        1               
         Syringes                          single lumen                     
                                           needle                           
                       880.5860           Piston syringe    1               
                                           (except                          
                                           antistick)                       
                       880.6920           Syringe needle    2               
                                           introducer                       
        Miscellaneous  880.2910           Clinical          2               
                                           electronic                       
                                           thermometer                      
                       880.2920           Clinical mercury  2               
                                           thermometer                      
                       880.5100           AC-powered        1               
                                           adjustable                       
                                           hospital bed                     
                       880.5500           AC-powered        2               
                                           patient lift                     
                       880.6880           Steam sterilizer  2               
                                           (greater than 2                  
                                           cubic feet)                      
    Neurology Panel                                                         
                       882.1020           Rigidity          2               
                                           analyzer                         
                       882.1610           Alpha monitor     2               
        Neuro-         882.1320           Cutaneous         2               
         Diagnostic                        electrode                        
                       882.1340           Nasopharyngeal    2               
                                           electrode                        
                       882.1350           Needle electrode  2               
                       882.1400           Electroencephalo  2               
                                           graph                            
                       882.1460           Nystagmograph     2               
                       882.1480           Neurological      2               
                                           endoscope                        
                       882.1540           Galvanic skin     2               
                                           response                         
                                           measurement                      
                                           device                           
                       882.1550           Nerve conduction  2               
                                           velocity                         
                                           measurement                      
                                           device                           
                       882.1560           Skin potential    2               
                                           measurement                      
                                           device                           
                       882.1570           Powered direct-   2               
                                           contact                          
                                           temperature                      
                                           measurement                      
                                           device                           
    
    [[Page 17765]]
    
                                                                            
                       882.1620           Intracranial      2               
                                           pressure                         
                                           monitoring                       
                                           device                           
                       882.1835           Physiological     2               
                                           signal                           
                                           amplifier                        
                       882.1845           Physiological     2               
                                           signal                           
                                           conditioner                      
                       882.1855           Electroencephalo  2               
                                           gram (EEG)                       
                                           telemetry                        
                                           system                           
                       882.5050           Biofeedback       2               
                                           device                           
        Echoencephalo  882.1240           Echoencephalogra  2               
         graphy                            ph                               
        RPG            882.4400           Radiofrequency    2               
                                           lesion                           
                                           generator                        
        Neuro Surgery  none               Electrode,        2               
                                           spinal epidural                  
                       882.4305           Powered compound  2               
                                           cranial drills,                  
                                           burrs,                           
                                           trephines, and                   
                                           their                            
                                           accessories                      
                       882.4310           Powered simple    2               
                                           cranial drills                   
                                           burrs,                           
                                           trephines, and                   
                                           their                            
                                           accessories                      
                       882.4360           Electric cranial  2               
                                           drill motor                      
                       882.4370           Pneumatic         2               
                                           cranial drill                    
                                           motor                            
                       882.4560           Stereotaxic       2               
                                           instrument                       
                       882.4725           Radiofrequency    2               
                                           lesion probe                     
                       882.4845           Powered rongeur   2               
                       882.5500           Lesion            2               
                                           temperature                      
                                           monitor                          
        Stimulators    882.1870           Evoked response   2               
                                           electrical                       
                                           stimulator                       
                       882.1880           Evoked response   2               
                                           mechanical                       
                                           stimulator                       
                       882.1890           Evoked response   2               
                                           photic                           
                                           stimulator                       
                       882.1900           Evoked response   2               
                                           auditory                         
                                           stimulator                       
                       882.1950           Tremor            2               
                                           transducer                       
                       882.5890           Transcutaneous    2               
                                           electrical                       
                                           nerve                            
                                           stimulator for                   
                                           pain relief                      
    Obstetrics/                                                             
     Gynecology Panel                                                       
        Fetal          884.1660           Transcervical     2               
         Monitoring                        endoscope                        
                                           (amnioscope)                     
                                           and accessories                  
                       884.1690           Hysteroscope and  2               
                                           accessories                      
                                           (for                             
                                           performance                      
                                           standards)                       
                       884.2225           Obstetric-        2               
                                           gynecologic                      
                                           ultrasonic                       
                                           imager                           
                       884.2600           Fetal cardiac     2               
                                           monitor                          
                       884.2640           Fetal             2               
                                           phonocardiograp                  
                                           hic monitor and                  
                                           accessories                      
                       884.2660           Fetal ultrasonic  2               
                                           monitor and                      
                                           accessories                      
                       884.2675           Fetal scalp       1               
                                           circular                         
                                           (spiral)                         
                                           electrode and                    
                                           applicator                       
                       884.2700           Intrauterine      2               
                                           pressure                         
                                           monitor and                      
                                           accessories                      
                       884.2720           External uterine  2               
                                           contraction                      
                                           monitor and                      
                                           accessories                      
                       884.2740           Perinatal         2               
                                           monitoring                       
                                           system and                       
                                           accessories                      
                       884.2960           Obstetric         2               
                                           ultrasonic                       
                                           transducer and                   
                                           accessories                      
        Gynecological  884.1720           Gynecologic       2               
         Surgery                           laparoscope and                  
         Equipment                         accessories                      
                       884.4160           Unipolar          2               
                                           endoscopic                       
                                           coagulator-                      
                                           cutter and                       
                                           accessories                      
                       884.4550           Gynecologic       2               
                                           surgical laser                   
                       884.4120           Gynecologic       2               
                                           electrocautery                   
                                           and accessories                  
                       884.5300           Condom            2               
        Ophthalmic     886.3320           Eye sphere        2               
         Implants                          implant                          
        Contact Lens   886.1385           Polymethylmethac  2               
                                           rylate (PMMA)                    
                                           diagnostic                       
                                           contact lens                     
                       886.5916           Rigid gas         2               
                                           permeable                        
                                           contact lens                     
                                           (daily wear                      
                                           only)                            
        Diagnostic     886.1120           Opthalmic camera  1               
         Equipment                                                          
                       886.1220           Corneal           1               
                                           electrode                        
                       886.1250           Euthyscope (AC-   1               
                                           powered)                         
                       886.1360           Visual field      1               
                                           laser                            
                                           instrument                       
    
    [[Page 17766]]
    
                                                                            
                       886.1510           Eye movement      1               
                                           monitor                          
                       886.1570           Ophthalmoscope    1               
                       886.1630           AC-powered        1               
                                           photostimulator                  
                       886.1640           Ophthalmic        1               
                                           preamplifier                     
                       886.1670           Ophthalmic        2               
                                           isotope uptake                   
                                           probe                            
                       886.1780           Retinoscope (AC-  1               
                                           powered device)                  
                       886.1850           AC-powered slit   1               
                                           lamp                             
                                           biomicroscope                    
                       886.1930           Tonometer and     2               
                                           accessories                      
                       886.1945           Transilluminator  1               
                                           (AC-powered                      
                                           device)                          
                       886.3130           Ophthalmic        2               
                                           conformer                        
        (Diagnostic/   886.4670           Phacofragmentati  2               
         Surgery                           on system                        
         Equipment)                                                         
         Ophthalmic    886.3340           Extraocular       2               
         Implants                          orbital implant                  
                       886.3800           Scleral shell     2               
        Surgical        880.5725          Infusion pump     2               
         Equipment                         (performance                     
                                           standards)                       
                       886.3100           Ophthalmic        2               
                                           tantalum clip                    
                       886.3300           Absorbable        2               
                                           implant                          
                                           (scleral                         
                                           buckling                         
                                           method)                          
                       886.4100           Radiofrequency    2               
                                           electrosurgical                  
                                           cautery                          
                                           apparatus                        
                       886.4115           Thermal cautery   2               
                                           unit                             
                       886.4150           Vitreous          2               
                                           aspiration and                   
                                           cutting                          
                                           instrument                       
                       886.4170           Cryophthalmic     2               
                                           unit                             
                       886.4250           Ophthalmic        1               
                                           electrolysis                     
                                           unit (AC-                        
                                           powered device)                  
                       886.4335           Operating         1               
                                           headlamp (AC-                    
                                           powered device)                  
                       886.4390           Ophthalmic laser  2               
                       886.4392           Nd:YAG laser for  2               
                                           posterior                        
                                           capsulotomy                      
                       886.4400           Electronic metal  1               
                                           locator                          
                       886.4440           AC-powered        1               
                                           magnet                           
                       886.4610           Ocular pressure   2               
                                           applicator                       
                       886.4690           Ophthalmic        2               
                                           photocoagulator                  
                       886.4790           Ophthalmic        2               
                                           sponge                           
                       886.5100           Ophthalmic beta   2               
                                           radiation                        
                                           source                           
                       none               Ophthalmoscopes,  1               
                                           replacement                      
                                           batteries, hand-                 
                                           held                             
    Orthopedic Panel                                                        
        Implants       888.3010           Bone fixation     2               
                                           cerclage                         
                       888.3020           Intramedullary    2               
                                           fixation rod                     
                       888.3030           Single/multiple   2               
                                           component                        
                                           metallic bone                    
                                           fixation                         
                                           appliances and                   
                                           accessories                      
                       888.3040           Smooth or         2               
                                           threaded                         
                                           metallic bone                    
                                           fixation                         
                                           fastener                         
                       888.3050           Spinal            2               
                                           interlaminal                     
                                           fixation                         
                                           orthosis                         
                       888.3060           Spinal            2               
                                           intervertebral                   
                                           body fixation                    
                                           orthosis                         
        Surgical       888.1240           AC-powered        2               
         Equipment                         dynamometer                      
                       888.4580           Sonic surgical    2               
                                           instrument and                   
                                           accessories/                     
                                           attachments                      
                       none               Accessories,      2               
                                           fixation,                        
                                           spinal                           
                                           interlaminal                     
                       none               Accessories,      2               
                                           fixation,                        
                                           spinal                           
                                           intervertebral                   
                                           body                             
                       none               Monitor,          1               
                                           pressure,                        
                                           intracompartmen                  
                                           tal                              
                       none               Orthosis,         2               
                                           fixation,                        
                                           spinal                           
                                           intervertebral                   
                                           fusion                           
                       none               Orthosis, spinal                  
                                           pedicle                          
                                           fixation                         
                       none               System, cement    1               
                                           removal                          
                                           extraction                       
    
    [[Page 17767]]
    
                                                                            
    Physical Medicine                                                       
     Panel                                                                  
        Diagnostic     890.1225           Chronaximeter     2               
         Equipment or                                                       
         (Therapy)                                                          
         Therapeutic                                                        
         Equipment                                                          
                       890.1375           Diagnostic        2               
                                           electromyograph                  
                       890.1385           Diagnostic        2               
                                           electromyograph                  
                                           needle                           
                                           electrode                        
                       890.1450           Powered reflex    2               
                                           hammer                           
                       890.1850           Diagnostic        2               
                                           muscle                           
                                           stimulator                       
        or (Therapy)   890.5850           Powered muscle    2               
                                           stimulator                       
        Therapeutic    890.5100           Immersion         2               
         Equipment                         hydrobath                        
                       890.5110           Paraffin bath     2               
                       890.5500           Infrared lamp     2               
                       890.5720           Water             2               
                                           circulating hot                  
                                           or cold pack                     
                       890.5740           Powered heating   2               
                                           pad                              
    Radiology Panel                                                         
        MRI            892.1000           Magnetic          2               
                                           resonance                        
                                           diagnostic                       
                                           device                           
        Ultrasound     884.2660           Fetal ultrasonic  2               
         Diagnostic                        monitor and                      
                                           accessories                      
                       892.1540           Nonfetal                          
                                           ultrasonic                       
                                           monitor                          
                       892.1560           Ultrasonic        2               
                                           pulsed echo                      
                                           imaging system                   
                       892.1570           Diagnostic        2               
                                           ultrasonic                       
                                           transducer                       
                       892.1550           Ultrasonic                        
                                           pulsed doppler                   
                                           imaging system                   
        Angiographic   892.1600           Angiographic x-   2               
                                           ray system                       
        Diagnostic X-  892.1610           Diagnostic x-ray  2               
         Ray                               beam-limiting                    
                                           device                           
                       892.1620           Cine or spot      2               
                                           fluorographic x-                 
                                           ray camera                       
                       892.1630           Electrostatic x-  2               
                                           ray imaging                      
                                           system                           
                       892.1650           Image-            2               
                                           intensified                      
                                           fluoroscopic x-                  
                                           ray system                       
                       892.1670           Spot film device  2               
                       892.1680           Stationary x-ray  2               
                                           system                           
                       892.1710           Mammographic x-   2               
                                           ray system                       
                       892.1720           Mobile x-ray      2               
                                           system                           
                       892.1740           Tomographic x-    1               
                                           ray system                       
                       892.1820           Pneumoencephalog  2               
                                           raphic chair                     
                       892.1850           Radiographic      1               
                                           film cassette                    
                       892.1860           Radiographic      1               
                                           film/cassette                    
                                           changer                          
                       892.1870           Radiographic      2               
                                           film/cassette                    
                                           changer                          
                                           programmer                       
                       892.1900           Automatic         2               
                                           radiographic                     
                                           film processor                   
                       892.1980           Radiologic table  1               
        CT Scanner     892.1750           Computed          2               
                                           tomography x-                    
                                           ray system                       
        Radiation      892.5050           Medical charged-  2               
         Therapy                           particle                         
                                           radiation                        
                                           therapy system                   
                       892.5300           Medical neutron   2               
                                           radiation                        
                                           therapy system                   
                       892.5700           Remote            2               
                                           controlled                       
                                           radionuclide                     
                                           applicator                       
                                           system                           
                       892.5710           Radiation         2               
                                           therapy beam-                    
                                           shaping block                    
                       892.5730           Radionuclide      2               
                                           brachytherapy                    
                                           source                           
                       892.5750           Radionuclide      2               
                                           radiation                        
                                           therapy system                   
                       892.5770           Powered           2               
                                           radiation                        
                                           therapy patient                  
                                           support                          
                                           assembly                         
                       892.5840           Radiation         2               
                                           therapy                          
                                           simulation                       
                                           system                           
                       892.5930           Therapeutic x-    1               
                                           ray tube                         
                                           housing                          
                                           assembly                         
        Nuclear        892.1170           Bone              2               
         Medicine                          densitometer                     
                       892.1200           Emission          2               
                                           computed                         
                                           tomography                       
                                           system                           
    
    [[Page 17768]]
    
                                                                            
                       892.1310           Nuclear           1               
                                           tomography                       
                                           system                           
                       892.1390           Radionuclide      2               
                                           rebreathing                      
                                           system                           
    General/Plastic                                                         
     Surgery Panel                                                          
        Surgical       878.4630           Ultraviolet lamp  2               
         Lamps                             for                              
                                           dermatologic                     
                                           disorders                        
                       890.5500           Infrared lamp     2               
                       878.4580           Surgical lamp     2               
        Electrosurgic  878.4810           Laser surgical    2               
         al Cutting                        instrument for                   
         Equipment                         use in general                   
                                           and plastic                      
                                           surgery and in                   
                                           dermatology                      
                       878.4400           Electrosurgical   2               
                                           cutting and                      
                                           coagulation                      
                                           device and                       
                                           accessories                      
        Miscellaneous  878.4780           Powered suction   2               
                                           pump                             
    ------------------------------------------------------------------------
    \1\Descriptive information on product codes, panel codes, and other     
      medical device identifiers may be viewed on FDA's Internet Web Site at
      ``http://www.fda.gov/cdrh/prodcode.html''.                            
    
    Appendix C of Subpart B [Reserved]
    
    Appendix D of Subpart B [Reserved]
    
    Appendix E of Subpart B [Reserved]
    
    Appendix F of Subpart B [Reserved]
    
    Subpart C--Framework or ``Umbrella'' Provisions
    
    
    Sec. 26.60  Definitions.
    
        (a) The following terms and definitions shall apply to this part 
    only:
        (1) Designating Authority means a body with power to designate, 
    monitor, suspend, remove suspension of, or withdraw conformity 
    assessment bodies as specified under this part.
        (2) Designation means the identification by a designating authority 
    of a conformity assessment body to perform conformity assessment 
    procedures under this part.
        (3) Regulatory Authority means a government agency or entity that 
    exercises a legal right to control the use or sale of products within a 
    party's jurisdiction and may take enforcement action to ensure that 
    products marketed within its jurisdiction comply with legal 
    requirements.
        (b) Other terms concerning conformity assessment used in this part 
    shall have the meaning given elsewhere in this part or in the 
    definitions contained in Guide 2 (1996 edition) of the International 
    Organization for Standardization (ISO) and the International 
    Electrotechnical Commission (IEC). In the event of an inconsistency 
    between the ISO/IEC Guide 2 and definitions in this part, the 
    definitions in this part shall prevail. The ISO/IEC Guide 2 is 
    incorporated by reference with the approval of the Director of the 
    Federal Register in accordance with 5 U.S.C. 552(a) and 1 CFR part 51. 
    Copies are available from the International Organization for 
    Standardization, 1, rue de Varembe, Case postale 56, CH-1211 Geneve 20, 
    Switzerland, or on the Internet at ``http://www.iso.ch'' or may be 
    examined at the Food and Drug Administration's Medical Library, 5600 
    Fishers Lane, rm. 11B-40, Rockville, MD 20857, or the Office of the 
    Federal Register, 800 North Capitol St. NW., suite 700, Washington, DC.
    
    
    Sec. 26.61  Purpose of this part.
    
         This part specifies the conditions by which each party will accept 
    or recognize results of conformity assessment procedures, produced by 
    the other party's conformity assessment bodies (CAB's) or authorities, 
    in assessing conformity to the importing party's requirements, as 
    specified on a sector-specific basis in subparts A and B of this part, 
    and to provide for other related cooperative activities. The objective 
    of such mutual recognition is to provide effective market access 
    throughout the territories of the parties with regard to conformity 
    assessment for all products covered under this part. If any obstacles 
    to such access arise, consultations will promptly be held. In the 
    absence of a satisfactory outcome of such consultations, the party 
    alleging its market access has been denied, may, within 90 days of such 
    consultation, invoke its right to terminate this part in accordance 
    with Sec. 26.80.
    
    
    Sec. 26.62  General obligations.
    
        (a) The United States shall, as specified in subparts A and B of 
    this part, accept or recognize results of specified procedures, used in 
    assessing conformity to specified legislative, regulatory, and 
    administrative provisions of the United States, produced by the other 
    party's conformity assessment bodies (CAB's) and/or authorities.
        (b) The European Community (EC) and its Member States shall, as 
    specified in subparts A and B of this part, accept or recognize results 
    of specified procedures, used in assessing conformity to specified 
    legislative, regulatory, and administrative provisions of the EC and 
    its Member States, produced by the other party's CAB's and/or 
    authorities.
        (c) Where sectoral transition arrangements have been specified in 
    subparts A and B of this part, the above obligations will apply 
    following the successful completion of those sectoral transition 
    arrangements, with the understanding that the conformity assessment 
    procedures utilized assure conformity to the satisfaction of the 
    receiving party, with applicable legislative, regulatory, and 
    administrative provisions of that party, equivalent to the assurance 
    offered by the receiving party's own procedures.
    
    
    Sec. 26.63   General coverage of this part.
    
        (a) This part applies to conformity assessment procedures for 
    products and/or processes and to other related cooperative activities 
    as described in this part.
        (b) Subparts A and B of this part may include:
        (1) A description of the relevant legislative, regulatory, and 
    administrative provisions pertaining to the conformity assessment 
    procedures and technical regulations;
        (2) A statement on the product scope and coverage;
        (3) A list of designating authorities;
        (4) A list of agreed conformity assessment bodies (CAB's) or 
    authorities or a source from which to obtain a list of such bodies or 
    authorities and a statement of the scope of the conformity assessment 
    procedures for which each has been agreed;
        (5) The procedures and criteria for designating the CAB's;
    
    [[Page 17769]]
    
        (6) A description of the mutual recognition obligations;
        (7) A sectoral transition arrangement;
        (8) The identity of a sectoral contact point in each party's 
    territory; and
        (9) A statement regarding the establishment of a Joint Sectoral 
    Committee.
        (c) This part shall not be construed to entail mutual acceptance of 
    standards or technical regulations of the parties and, unless otherwise 
    specified in subpart A or B of this part, shall not entail the mutual 
    recognition of the equivalence of standards or technical regulations.
    
    
    Sec. 26.64   Transitional arrangements.
    
        The parties agree to implement the transitional commitments on 
    confidence building as specified in subparts A and B of this part.
        (a) The parties agree that each sectoral transitional arrangement 
    shall specify a time period for completion.
        (b) The parties may amend any transitional arrangement by mutual 
    agreement.
        (c) Passage from the transitional phase to the operational phase 
    shall proceed as specified in subparts A and B of this part, unless 
    either party documents that the conditions provided in such subpart for 
    a successful transition are not met.
    
    
    Sec. 26.65   Designating authorities.
    
        The parties shall ensure that the designating authorities specified 
    in subpart B of this part have the power and competence in their 
    respective territories to carry out decisions under this part to 
    designate, monitor, suspend, remove suspension of, or withdraw 
    conformity assessment bodies (CAB's).
    
    
    Sec. 26.66   Designation and listing procedures.
    
        The following procedures shall apply with regard to the designation 
    of conformity assessment bodies (CAB's) and the inclusion of such 
    bodies in the list of CAB's in subpart B of this part:
        (a) The designating authority identified in subpart B of this part 
    shall designate CAB's in accordance with the procedures and criteria 
    set forth in subpart B of this part;
        (b) A party proposing to add a CAB to the list of such bodies in 
    subpart B of this part shall forward its proposal of one or more 
    designated CAB's in writing to the other party with a view to a 
    decision by the Joint Committee;
        (c) Within 60 days following receipt of the proposal, the other 
    party shall indicate its position regarding either its confirmation or 
    its opposition. Upon confirmation, the inclusion in subpart B of this 
    part of the proposed CAB or CAB's shall take effect; and
        (d) In the event that the other party contests on the basis of 
    documented evidence the technical competence or compliance of a 
    proposed CAB, or indicates in writing that it requires an additional 30 
    days to more fully verify such evidence, such CAB shall not be included 
    on the list of CAB's in subpart B of this part. In this instance, the 
    Joint Committee may decide that the body concerned be verified. After 
    the completion of such verification, the proposal to list the CAB in 
    subpart B may be resubmitted to the other party.
    
    
    Sec. 26.67  Suspension of listed conformity assessment bodies.
    
        The following procedures shall apply with regard to the suspension 
    of a conformity assessment body (CAB) listed in subpart B of this part.
        (a) A party shall notify the other party of its contestation of the 
    technical competence or compliance of a CAB listed in subpart B of this 
    part and the contesting party's intent to suspend such CAB. Such 
    contestation shall be exercised when justified in an objective and 
    reasoned manner in writing to the other party;
        (b) The CAB shall be given prompt notice by the other party and an 
    opportunity to present information in order to refute the contestation 
    or to correct the deficiencies which form the basis of the 
    contestation;
        (c) Any such contestation shall be discussed between the parties in 
    the Joint Sectoral Committee described in subpart B of this part. If 
    there is no Joint Sectoral Committee, the contesting party shall refer 
    the matter directly to the Joint Committee. If agreement to suspend is 
    reached by the Joint Sectoral Committee or, if there is no Joint 
    Sectoral Committee, by the Joint Committee, the CAB shall be suspended;
        (d) Where the Joint Sectoral Committee or Joint Committee decides 
    that verification of technical competence or compliance is required, it 
    shall normally be carried out in a timely manner by the party in whose 
    territory the body in question is located, but may be carried out 
    jointly by the parties in justified cases;
        (e) If the matter has not been resolved by the Joint Sectoral 
    Committee within 10 days of the notice of contestation, the matter 
    shall be referred to the Joint Committee for a decision. If there is no 
    Joint Sectoral Committee, the matter shall be referred directly to the 
    Joint Committee. If no decision is reached by the Joint Committee 
    within 10 days of the referral to it, the CAB shall be suspended upon 
    the request of the contesting party;
        (f) Upon the suspension of a CAB listed in subpart B of this part, 
    a party is no longer obligated to accept or recognize the results of 
    conformity assessment procedures performed by that CAB subsequent to 
    suspension. A party shall continue to accept the results of conformity 
    assessment procedures performed by that CAB prior to suspension, unless 
    a regulatory authority of the party decides otherwise based on health, 
    safety or environmental considerations or failure to satisfy other 
    requirements within the scope of subpart B of this part; and
        (g) The suspension shall remain in effect until agreement has been 
    reached by the parties upon the future status of that body.
    
    
    Sec. 26.68   Withdrawal of listed conformity assessment bodies.
    
        The following procedures shall apply with regard to the withdrawal 
    from subpart B of this part of a conformity assessment body (CAB):
        (a) A party proposing to withdraw a CAB listed in subpart B of this 
    part shall forward its proposal in writing to the other party;
        (b) Such CAB shall be promptly notified by the other party and 
    shall be provided a period of at least 30 days from receipt to provide 
    information in order to refute or to correct the deficiencies which 
    form the basis of the proposed withdrawal;
        (c) Within 60 days following receipt of the proposal, the other 
    party shall indicate its position regarding either its confirmation or 
    its opposition. Upon confirmation, the withdrawal from the list in 
    subpart B of this part of the CAB shall take effect;
        (d) In the event the other party opposes the proposal to withdraw 
    by supporting the technical competence and compliance of the CAB, the 
    CAB shall not at that time be withdrawn from the list of CAB's in 
    subpart B of this part. In this instance, the Joint Sectoral Committee 
    or the Joint Committee may decide to carry out a joint verification of 
    the body concerned. After the completion of such verification, the 
    proposal for withdrawal of the CAB may be resubmitted to the other 
    party; and
        (e) Subsequent to the withdrawal of a CAB listed in subpart B of 
    this part, a party shall continue to accept the results of conformity 
    assessment procedures performed by that CAB prior to withdrawal, unless 
    a regulatory authority of the party decides otherwise based on health, 
    safety, and environmental considerations or failure to satisfy other 
    requirements within the scope of subpart B of this part.
    
    [[Page 17770]]
    
    Sec. 26.69   Monitoring of conformity assessment bodies.
    
        The following shall apply with regard to the monitoring of 
    conformity assessment bodies (CAB's) listed in subpart B of this part:
        (a) Designating authorities shall assure that their CAB's listed in 
    subpart B of this part are capable and remain capable of properly 
    assessing conformity of products or processes, as applicable, and as 
    covered in subpart B of this part. In this regard, designating 
    authorities shall maintain, or cause to maintain, ongoing surveillance 
    over their CAB's by means of regular audit or assessment;
        (b) The parties undertake to compare methods used to verify that 
    the CAB's listed in subpart B of this part comply with the relevant 
    requirements of subpart B of this part. Existing systems for the 
    evaluation of CAB's may be used as part of such comparison procedures;
        (c) Designating authorities shall consult as necessary with their 
    counterparts, to ensure the maintenance of confidence in conformity 
    assessment procedures. With the consent of both parties, this 
    consultation may include joint participation in audits/inspections 
    related to conformity assessment activities or other assessments of 
    CAB's listed in subpart B of this part; and
        (d) Designating authorities shall consult, as necessary, with the 
    relevant regulatory authorities of the other party to ensure that all 
    technical requirements are identified and are satisfactorily addressed.
    
    
    Sec. 26.70   Conformity assessment bodies.
    
        Each party recognizes that the conformity assessment bodies (CAB's) 
    listed in subpart B of this part fulfill the conditions of eligibility 
    to assess conformity in relation to its requirements as specified in 
    subpart B of this part. The parties shall specify the scope of the 
    conformity assessment procedures for which such bodies are listed.
    
    
    Sec. 26.71   Exchange of information.
    
        (a) The parties shall exchange information concerning the 
    implementation of the legislative, regulatory, and administrative 
    provisions identified in subparts A and B of this part.
        (b) Each party shall notify the other party of legislative, 
    regulatory, and administrative changes related to the subject matter of 
    this part at least 60 days before their entry into force. Where 
    considerations of safety, health or environmental protection require 
    more urgent action, a party shall notify the other party as soon as 
    practicable.
        (c) Each party shall promptly notify the other party of any changes 
    to its designating authorities and/or conformity assessment bodies 
    (CAB's).
        (d) The parties shall exchange information concerning the 
    procedures used to ensure that the listed CAB's under their 
    responsibility comply with the legislative, regulatory, and 
    administrative provisions outlined in subpart B of this part.
        (e) Regulatory authorities identified in subparts A and B of this 
    part shall consult as necessary with their counterparts, to ensure the 
    maintenance of confidence in conformity assessment procedures and to 
    ensure that all technical requirements are identified and are 
    satisfactorily addressed.
    
    
     Sec. 26.72   Sectoral contact points.
    
        Each party shall appoint and confirm in writing contact points to 
    be responsible for activities under subparts A and B of this part.
    
    
    Sec. 26.73   Joint Committee.
    
        (a) A Joint Committee consisting of representatives of the United 
    States and the European Community (EC) will be established. The Joint 
    Committee shall be responsible for the effective functioning of this 
    part.
        (b) The Joint Committee may establish Joint Sectoral Committees 
    comprised of appropriate regulatory authorities and others deemed 
    necessary.
        (c) The United States and the EC shall have one vote in the Joint 
    Committee. The Joint Committee shall make its decisions by unanimous 
    consent. The Joint Committee shall determine its own rules and 
    procedures.
        (d) The Joint Committee may consider any matter relating to the 
    effective functioning of this part. In particular it shall be 
    responsible for:
        (1) Listing, suspension, withdrawal and verification of conformity 
    assessment bodies (CAB's) in accordance with this subpart and subpart B 
    of this part;
        (2) Amending transitional arrangements in subparts A and B of this 
    part;
        (3) Resolving any questions relating to the application of this 
    part not otherwise resolved in the respective Joint Sectoral 
    Committees;
        (4) Providing a forum for discussion of issues that may arise 
    concerning the implementation of this part;
        (5) Considering ways to enhance the operation of this part;
        (6) Coordinating the negotiation of additional subparts; and
        (7) Considering whether to amend this part in accordance with 
    Sec. 26.80.
        (e) When a party introduces new or additional conformity assessment 
    procedures affecting subpart A or B of this part, the parties shall 
    discuss the matter in the Joint Committee with a view to bringing such 
    new or additional procedures within the scope of this part, where 
    relevant.
    
    
     Sec. 26.74   Preservation of regulatory authority.
    
        (a) Nothing in this part shall be construed to limit the authority 
    of a party to determine, through its legislative, regulatory, and 
    administrative measures, the level of protection it considers 
    appropriate for safety; for protection of human, animal, or plant life 
    or health; for the environment; for consumers; and otherwise with 
    regard to risks within the scope of the applicable subpart A or B of 
    this part.
        (b) Nothing in this part shall be construed to limit the authority 
    of a regulatory authority to take all appropriate and immediate 
    measures whenever it ascertains that a product may:
        (1) Compromise the health or safety of persons in its territory;
        (2) Not meet the legislative, regulatory, or administrative 
    provisions within the scope of the applicable subpart A or B of this 
    part; or
        (3) Otherwise fail to satisfy a requirement within the scope of the 
    applicable subpart A or B of this part. Such measures may include 
    withdrawing the products from the market, prohibiting their placement 
    on the market, restricting their free movement, initiating a product 
    recall, and preventing the recurrence of such problems, including 
    through a prohibition on imports. If the regulatory authority takes 
    such action, it shall inform its counterpart authority and the other 
    party within 15 days of taking such action, providing its reasons.
    
    
    Sec. 26.75   Suspension of recognition obligations.
    
        Either party may suspend its obligations under subpart A or B of 
    this part, in whole or in part, if:
        (a) A party suffers a loss of market access for the party's 
    products within the scope of subpart A or B of this part as a result of 
    the failure of the other party to fulfill its obligations under this 
    part;
        (b) The adoption of new or additional conformity assessment 
    requirements as referenced in Sec. 26.73(e) results in a loss of market 
    access for the party's products within the scope of subpart B of this 
    part because conformity assessment bodies (CAB's) designated by the 
    party in order to meet such requirements have not been recognized by 
    the party implementing the requirements; or
    
    [[Page 17771]]
    
        (c) The other party fails to maintain legal and regulatory 
    authorities capable of implementing the provisions of this part.
    
    
    Sec. 26.76  Confidentiality.
    
        (a) Each party agrees to maintain, to the extent required under its 
    laws, the confidentiality of information exchanged under this part.
        (b) In particular, neither party shall disclose to the public, nor 
    permit a conformity assessment body (CAB) to disclose to the public, 
    information exchanged under this part that constitutes trade secrets, 
    confidential commercial or financial information, or information that 
    relates to an ongoing investigation.
        (c) A party or a CAB may, upon exchanging information with the 
    other party or with a CAB of the other party, designate the portions of 
    the information that it considers to be exempt from disclosure.
        (d) Each party shall take all precautions reasonably necessary to 
    protect information exchanged under this part from unauthorized 
    disclosure.
    
    
     Sec. 26.77   Fees.
    
        Each party shall endeavor to ensure that fees imposed for services 
    under this part shall be commensurate with the services provided. Each 
    party shall ensure that, for the sectors and conformity assessment 
    procedures covered under this part, it shall charge no fees with 
    respect to conformity assessment services provided by the other party.
    
    
     Sec. 26.78   Agreements with other countries.
    
        Except where there is written agreement between the parties, 
    obligations contained in mutual recognition agreements concluded by 
    either party with a party not a party to this part (a third party) 
    shall have no force and effect with regard to the other party in terms 
    of acceptance of the results of conformity assessment procedures in the 
    third party.
    
    
    Sec. 26.79   Territorial application.
    
        This part shall apply, on the one hand, to the territories in which 
    the Treaty establishing the European Community (EC) is applied, and 
    under the conditions laid down in that Treaty and, on the other hand, 
    to the territory of the United States.
    
    
    Sec. 26.80  Entry into force, amendment and termination.
    
        (a) The ``Agreement on Mutual Recognition Between the United States 
    of America and the European Community,'' from which this part is 
    derived, including its sectoral annexes on telecommunications 
    equipment, electromagnetic compatibility, electrical safety, 
    recreational craft, pharmaceutical GMP inspections, and medical devices 
    shall enter into force on the first day of the second month following 
    the date on which the parties have exchanged letters confirming the 
    completion of their respective procedures for the entry into force of 
    that agreement.
        (b) That agreement including any sectoral annex may, through the 
    Joint Committee, be amended in writing by the parties to that 
    agreement. Those parties may add a sectoral annex upon the exchange of 
    letters. Such annex shall enter into force 30 days following the date 
    on which those parties have exchanged letters confirming the completion 
    of their respective procedures for the entry into force of the sectoral 
    annex.
        (c) Either party to that agreement may terminate that agreement in 
    its entirety or any individual sectoral annex thereof by giving the 
    other party to that agreement 6 months notice in writing. In the case 
    of termination of one or more sectoral annexes, the parties to that 
    agreement will seek to achieve by consensus to amend that agreement, 
    with a view to preserving the remaining Sectoral Annexes, in accordance 
    with the procedures in this section. Failing such consensus, that 
    agreement shall terminate at the end of 6 months.
        (d) Following termination of that agreement in its entirety or any 
    individual sectoral annex thereof, a party to that agreement shall 
    continue to accept the results of conformity assessment procedures 
    performed by conformity assessment bodies under that agreement prior to 
    termination, unless a regulatory authority in the party decides 
    otherwise based on health, safety and environmental considerations or 
    failure to satisfy other requirements within the scope of the 
    applicable sectoral annex.
    
    
    Sec. 26.81  Final provisions.
    
        (a) The sectoral annexes referred to in Sec. 26.80(a), as well as 
    any new sectoral annexes added pursuant to Sec. 26.80(b), shall form an 
    integral part of the ``Agreement on Mutual Recognition Between the 
    United States of America and the European Community,'' from which this 
    part is derived.
        (b) For a given product or sector, the provisions contained in 
    subparts A and B of this part shall apply in the first place, and the 
    provisions of subpart C of this part in addition to those provisions. 
    In the case of any inconsistency between the provisions of subpart A or 
    B of this part and subpart C of this part, subpart A or B shall 
    prevail, to the extent of that inconsistency.
        (c) The agreement from which this part is derived shall not affect 
    the rights and obligations of the parties under any other international 
    agreement.
        (d) In the case of subpart B of this part, the parties shall review 
    the status of such subpart at the end of 3 years from entry into force 
    of subpart B.
    
        Dated: April 6, 1998.
    William B. Schultz,
    Deputy Commissioner for Policy.
    [FR Doc. 98-9486 Filed 4-9-98; 8:45 am]
    BILLING CODE 4160-01-F
    
    
    

Document Information

Published:
04/10/1998
Department:
Food and Drug Administration
Entry Type:
Proposed Rule
Action:
Proposed rule.
Document Number:
98-9486
Dates:
Comments by May 11, 1998. Comments must be received by the
Pages:
17744-17771 (28 pages)
Docket Numbers:
Docket No. 95N-0185
RINs:
0910-ZA11
PDF File:
98-9486.pdf
CFR: (100)
21 CFR 26.8)
21 CFR 26.42(a)
21 CFR 26.32(a)
21 CFR 26.80(a)
21 CFR 26.0
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